Provider Demographics
NPI:1952446221
Name:PHILLIPS, TAMBRE ANNELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMBRE
Middle Name:ANNELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TAMBRE
Other - Middle Name:ANNELLE
Other - Last Name:ATCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3912 NORTHLAKE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3420
Mailing Address - Country:US
Mailing Address - Phone:770-934-2158
Mailing Address - Fax:
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-712-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist