Healthcare Provider Details

I. General information

NPI: 1992224380
Provider Name (Legal Business Name): TAMARA H LITTLE RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 CIRCLE DR
OXFORD AL
36203-3201
US

IV. Provider business mailing address

1311 CIRCLE DR
OXFORD AL
36203-3201
US

V. Phone/Fax

Practice location:
  • Phone: 334-329-8213
  • Fax:
Mailing address:
  • Phone: 334-329-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2538
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: