Healthcare Provider Details

I. General information

NPI: 1376709220
Provider Name (Legal Business Name): TAMARA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE FOB BLDG, SUITE 126
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

531 ASBURY CIR STE N340 ADMINISTRATION BUILDING, 10TH FLOOR
ATLANTA GA
30322-1006
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-5500
  • Fax:
Mailing address:
  • Phone: 404-686-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number64214
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: