Provider Demographics
NPI:1942279658
Name:OWENS, TAMMY WILBANKS (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:WILBANKS
Last Name:OWENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ELLENE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5136 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-5115
Mailing Address - Country:US
Mailing Address - Phone:706-499-3086
Mailing Address - Fax:
Practice Address - Street 1:5136 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-5115
Practice Address - Country:US
Practice Address - Phone:706-499-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146039NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01186539OtherAMERIGROUP
GA418247497EMedicaid
GA418247497DMedicaid
GA459304OtherWELLCARE
GA01186539OtherAMERIGROUP
GA511I500336Medicare PIN