Provider Demographics
NPI:1205671278
Name:TAMARA THORN DMSC, PA-C, LCSW PSYCHIATRIC PHYSICIAN ASSISTANT SERVICES
Entity type:Organization
Organization Name:TAMARA THORN DMSC, PA-C, LCSW PSYCHIATRIC PHYSICIAN ASSISTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. TAMARA IDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:THORN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, LCSW, CAADC
Authorized Official - Phone:704-898-7837
Mailing Address - Street 1:PO BOX 2687
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2687
Mailing Address - Country:US
Mailing Address - Phone:912-572-0358
Mailing Address - Fax:912-244-9958
Practice Address - Street 1:45 LULLWATER DR UNIT 617
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6612
Practice Address - Country:US
Practice Address - Phone:704-898-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMARA THORN DMSC, PA-C, LCSW PSYCHIATRIC PHYSICIAN ASSISTANT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty