Provider Demographics
NPI:1841589744
Name:AUSTIN, TAMARA D (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:D
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:D
Other - Last Name:GRIFFIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-834-4151
Mailing Address - Fax:864-834-6145
Practice Address - Street 1:406 N POINSETT HWY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690
Practice Address - Country:US
Practice Address - Phone:864-834-4151
Practice Address - Fax:864-834-6145
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1607363A00000X
SC363A00000X
ALPA.1344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1607OtherLICENSE NUMBER