Provider Demographics
NPI:1982741542
Name:RICHARDSON, TAMARA CHANETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:CHANETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:CHANETTE
Other - Last Name:CARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5408 SUMMERVILLE RD STE 155
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7843
Mailing Address - Country:US
Mailing Address - Phone:334-650-6692
Mailing Address - Fax:334-744-6211
Practice Address - Street 1:445 DEXTER AVE STE 4050
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-3867
Practice Address - Country:US
Practice Address - Phone:334-650-6692
Practice Address - Fax:334-744-6211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA1596363AM0700X
GA5806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical