Provider Demographics
NPI:1932738838
Name:ROWE, TAMMY SHENELL
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SHENELL
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 SAINT JUDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5432
Mailing Address - Country:US
Mailing Address - Phone:404-341-8211
Mailing Address - Fax:404-916-7022
Practice Address - Street 1:6632 SAINT JUDE DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5432
Practice Address - Country:US
Practice Address - Phone:678-682-4400
Practice Address - Fax:404-916-7022
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675326163W00000X
GARN248012163WA2000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator