Provider Demographics
NPI:1134151079
Name:SAPP, TINA MARIE ((ARRT )(RT)(MR))
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:SAPP
Suffix:
Gender:F
Credentials:(ARRT )(RT)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 HIGHWAY 215
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092
Mailing Address - Country:US
Mailing Address - Phone:229-322-2350
Mailing Address - Fax:
Practice Address - Street 1:1401 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3585
Practice Address - Country:US
Practice Address - Phone:229-387-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
195517247100000X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist