Provider Demographics
NPI:1467790915
Name:STEPHENS, TAMMY LYNN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6055 LAKESIDE COMMONS DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5791
Mailing Address - Country:US
Mailing Address - Phone:478-238-9344
Mailing Address - Fax:478-225-0566
Practice Address - Street 1:6055 LAKESIDE COMMONS DR STE 320
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5791
Practice Address - Country:US
Practice Address - Phone:478-238-9344
Practice Address - Fax:478-225-0566
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily