Healthcare Provider Details

I. General information

NPI: 1932125309
Provider Name (Legal Business Name): TAMILA GALE MAYBERRY P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PUTNAM AVE
ZANESVILLE OH
43701-5547
US

IV. Provider business mailing address

33 S 5TH ST
ZANESVILLE OH
43701-3510
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-9000
  • Fax:
Mailing address:
  • Phone: 740-891-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001988RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1067
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: