Provider Demographics
NPI:1477696243
Name:COOTS, TAMMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:COOTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EAGLES WALK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7204
Mailing Address - Country:US
Mailing Address - Phone:770-507-6044
Mailing Address - Fax:
Practice Address - Street 1:110 EAGLES WALK
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7204
Practice Address - Country:US
Practice Address - Phone:770-507-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002471103TC0700X
LA850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00892911AMedicaid