Provider Demographics
NPI:1790742294
Name:GEORGE, TAMARA ANN (MA CCC-A)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:KORNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-A
Mailing Address - Street 1:5675 DOBSON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-3449
Mailing Address - Country:US
Mailing Address - Phone:910-480-2575
Mailing Address - Fax:
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:AUDIOLOGY CLINIC
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-822-7088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3077231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist