Provider Demographics
NPI:1619691326
Name:SMOAK, TAMMIE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:MICHELLE
Last Name:SMOAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:KNIGHT
Other - Last Name:SMOAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 GREENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-4001
Practice Address - Country:US
Practice Address - Phone:803-777-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program