Provider Demographics
NPI:1255779682
Name:HAGAN, TAMMY (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 RENOIR CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5181
Mailing Address - Country:US
Mailing Address - Phone:404-944-0800
Mailing Address - Fax:770-478-8722
Practice Address - Street 1:3315 RENOIR CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5181
Practice Address - Country:US
Practice Address - Phone:404-944-0800
Practice Address - Fax:770-478-8722
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse