Healthcare Provider Details

I. General information

NPI: 1447457965
Provider Name (Legal Business Name): TAMMI B PAVEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMI L BALK PA-C

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 WALTON WAY
AUGUSTA GA
30904-2305
US

IV. Provider business mailing address

2050 WALTON WAY STE 201
AUGUSTA GA
30904-4163
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-1590
  • Fax: 706-434-1346
Mailing address:
  • Phone: 706-267-0793
  • Fax: 706-434-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3053
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003053
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: