Healthcare Provider Details

I. General information

NPI: 1649950825
Provider Name (Legal Business Name): TAMMY BOND MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLSON ST
GREENWOOD SC
29649-1623
US

IV. Provider business mailing address

1032 EMERALD RD
GREENWOOD SC
29646-8833
US

V. Phone/Fax

Practice location:
  • Phone: 864-323-5780
  • Fax:
Mailing address:
  • Phone: 864-323-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number206457
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: