Provider Demographics
NPI:1821684663
Name:ALLGOOD, TAMMY CHARYSSE (PCS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHARYSSE
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 PARKMAN RD NW APT 102
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-1647
Mailing Address - Country:US
Mailing Address - Phone:330-883-0719
Mailing Address - Fax:
Practice Address - Street 1:2831 PARKMAN RD NW APT 102
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-1647
Practice Address - Country:US
Practice Address - Phone:330-883-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340166Medicaid