Provider Demographics
NPI:1952359861
Name:WOJCIECHOWSKI, TAMARA (PHDC, CRNA, FAAPM)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WOJCIECHOWSKI
Suffix:
Gender:F
Credentials:PHDC, CRNA, FAAPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CROOKED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3366
Mailing Address - Country:US
Mailing Address - Phone:847-652-1505
Mailing Address - Fax:
Practice Address - Street 1:5401 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4232
Practice Address - Country:US
Practice Address - Phone:706-453-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001050208VP0014X
GARN169205367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine