Provider Demographics
NPI:1417513573
Name:HAYGARTH, TAMARA LYNN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:HAYGARTH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1540 GARDEN TER STE 402
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6110
Mailing Address - Country:US
Mailing Address - Phone:704-381-6829
Mailing Address - Fax:704-381-6811
Practice Address - Street 1:1001 BLYTHE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5865
Practice Address - Country:US
Practice Address - Phone:704-381-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17117170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS