Provider Demographics
NPI:1447593850
Name:TRADITIONAL NURSE TEAM TRIPODS
Entity Type:Organization
Organization Name:TRADITIONAL NURSE TEAM TRIPODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITATOR/WORKABEE
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:706-550-3760
Mailing Address - Street 1:2803 WRIGHTSBORO RD
Mailing Address - Street 2:STE 15-139
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3913
Mailing Address - Country:US
Mailing Address - Phone:706-373-2718
Mailing Address - Fax:
Practice Address - Street 1:2803 WRIGHTSBORO RD
Practice Address - Street 2:STE 15-139
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3913
Practice Address - Country:US
Practice Address - Phone:706-373-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070514163W00000X
172V00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty