Provider Demographics
NPI:1972663763
Name:MASSEY, TAMI Y (MD)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:Y
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 RIDGE MEDICAL PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-4531
Mailing Address - Country:US
Mailing Address - Phone:803-637-3146
Mailing Address - Fax:803-637-6597
Practice Address - Street 1:155 RIDGE MEDICAL PLAZA RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4531
Practice Address - Country:US
Practice Address - Phone:803-637-3146
Practice Address - Fax:803-637-6597
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL4308Medicaid
SCH98434Medicare UPIN
SCAA0230Medicare PIN
SCPA0267Medicaid