Provider Demographics
NPI:1942515390
Name:FAMBROUGH, TABITHA LIVINGSTON
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LIVINGSTON
Last Name:FAMBROUGH
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 1:7 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3211
Mailing Address - Country:US
Mailing Address - Phone:864-552-1679
Mailing Address - Fax:
Practice Address - Street 1:7 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3211
Practice Address - Country:US
Practice Address - Phone:864-552-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC150676R374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide