Provider Demographics
NPI:1629134606
Name:WILLIAMS, TAMMY WATKINS (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:WATKINS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:RENAE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:200 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8504
Practice Address - Country:US
Practice Address - Phone:470-490-6860
Practice Address - Fax:678-721-9457
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000949396AMedicaid
GA37BBGGPMedicare ID - Type Unspecified
GA000949396AMedicaid