Provider Demographics
NPI:1023882057
Name:JACKSON, TAMMY CHRISTY (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:CHRISTY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WORTHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2050
Mailing Address - Country:US
Mailing Address - Phone:478-396-5465
Mailing Address - Fax:
Practice Address - Street 1:226 WORTHINGTON LN
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2050
Practice Address - Country:US
Practice Address - Phone:478-396-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory