Provider Demographics
NPI:1801176458
Name:POWELL, TAMMY LYNN (MCD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:EASTERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3581 BRASELTON HWY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1027
Mailing Address - Country:US
Mailing Address - Phone:770-999-0421
Mailing Address - Fax:
Practice Address - Street 1:3581 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1027
Practice Address - Country:US
Practice Address - Phone:770-999-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist