Provider Demographics
NPI:1417125584
Name:SACKIE, TIMBRA D (BS)
Entity Type:Individual
Prefix:
First Name:TIMBRA
Middle Name:D
Last Name:SACKIE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TIMBRA
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:900 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6720
Practice Address - Country:US
Practice Address - Phone:423-232-4135
Practice Address - Fax:423-232-4145
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator