Provider Demographics
NPI:1205562261
Name:STANLEY, TAMMY (AIDE)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 BARRINGTON VW
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1846
Mailing Address - Country:US
Mailing Address - Phone:678-582-9317
Mailing Address - Fax:
Practice Address - Street 1:1607 BARRINGTON VW
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1846
Practice Address - Country:US
Practice Address - Phone:678-582-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9576376OtherCIGNA