Provider Demographics
NPI:1457462822
Name:EBY, TAMMY DAVIS (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DAVIS
Last Name:EBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7867
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0867
Mailing Address - Country:US
Mailing Address - Phone:252-451-2700
Mailing Address - Fax:252-451-2702
Practice Address - Street 1:10589 E NC HIGHWAY 97
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-9208
Practice Address - Country:US
Practice Address - Phone:252-442-1807
Practice Address - Fax:252-442-1649
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00134363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC187577OtherMEDCOST ID
NC429536OtherWELLPATH ID
NC7173829OtherAETNA ID
NC2765987Medicare PIN
NC429536OtherWELLPATH ID