Provider Demographics
NPI:1982845624
Name:DAVIDSON, TAMMY CHERYL (LGSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHERYL
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:CHERYL
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:2400 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-5001
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:334-725-2776
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2776
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2232G261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA