Provider Demographics
NPI:1497190631
Name:ANDERSON, TAMMY (DOM)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OFFICE PARK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4640
Mailing Address - Country:US
Mailing Address - Phone:843-949-9688
Mailing Address - Fax:
Practice Address - Street 1:32 OFFICE PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4640
Practice Address - Country:US
Practice Address - Phone:843-949-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist