Provider Demographics
NPI:1588029763
Name:MADDOX ANDERSON, TAMMY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MADDOX ANDERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BLACKBURN DR # 523
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8202
Mailing Address - Country:US
Mailing Address - Phone:706-524-7134
Mailing Address - Fax:706-247-7784
Practice Address - Street 1:519 BLACKBURN DR # 523
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-8202
Practice Address - Country:US
Practice Address - Phone:706-524-7134
Practice Address - Fax:706-247-7784
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health