Provider Demographics
NPI:1508631722
Name:UNDERWOOD, TAMARA (NP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:BRAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:241 DUNSTANS PASS
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3805 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2085
Practice Address - Country:US
Practice Address - Phone:770-426-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244845363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care