Provider Demographics
NPI:1598228033
Name:LOVE, TAMMI
Entity Type:Individual
Prefix:MS
First Name:TAMMI
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 EARNEST NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31771-5600
Mailing Address - Country:US
Mailing Address - Phone:480-229-5652
Mailing Address - Fax:
Practice Address - Street 1:1787 EARNEST NORMAN RD
Practice Address - Street 2:
Practice Address - City:NORMAN PARK
Practice Address - State:GA
Practice Address - Zip Code:31771-5600
Practice Address - Country:US
Practice Address - Phone:480-229-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052913025171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor