Provider Demographics
NPI:1821237769
Name:BUCHANAN, TAMMRA
Entity Type:Individual
Prefix:MS
First Name:TAMMRA
Middle Name:
Last Name:BUCHANAN
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 1:125 MEADOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-2054
Mailing Address - Country:US
Mailing Address - Phone:803-586-1588
Mailing Address - Fax:
Practice Address - Street 1:200 CLAUDE BUNDRICK RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9420
Practice Address - Country:US
Practice Address - Phone:803-754-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health