Provider Demographics
NPI:1548863780
Name:DORSEY, TAMMY (PHARMD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1100
Mailing Address - Country:US
Mailing Address - Phone:770-769-6040
Mailing Address - Fax:
Practice Address - Street 1:30 ORVIN LANCE CONNECTOR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4238
Practice Address - Country:US
Practice Address - Phone:706-632-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist