Provider Demographics
NPI:1942955547
Name:ROBERTSON, TAMMY ANN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:ROBERTSON
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 1:1321A INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5626
Mailing Address - Country:US
Mailing Address - Phone:706-922-9311
Mailing Address - Fax:706-738-7248
Practice Address - Street 1:1321A INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5626
Practice Address - Country:US
Practice Address - Phone:706-922-9311
Practice Address - Fax:706-738-7248
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA192339363LF0000X
GARN192339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily