Healthcare Provider Details

I. General information

NPI: 1215725155
Provider Name (Legal Business Name): TAMMY RENEE GRIGGS COMMERCIAL DRIVER'S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CRIMSON CIR
THOMASVILLE GA
31792-6912
US

IV. Provider business mailing address

132 CRIMSON CIR
THOMASVILLE GA
31792-6912
US

V. Phone/Fax

Practice location:
  • Phone: 229-379-7267
  • Fax:
Mailing address:
  • Phone: 229-379-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number053703403
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number053703403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: