Provider Demographics
NPI:1518157486
Name:WHITE, TAMMY (CFM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 T R HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3486
Mailing Address - Country:US
Mailing Address - Phone:704-487-5225
Mailing Address - Fax:
Practice Address - Street 1:105 T R HARRIS DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3486
Practice Address - Country:US
Practice Address - Phone:704-487-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFM01559335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCFMO1559OtherMASTECTOMY CERTIFIED FITT