Healthcare Provider Details

I. General information

NPI: 1992009302
Provider Name (Legal Business Name): TAMMY JOAN MARSH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: T J MARSH ATC

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

500 CARLEN AVE APT #7224
LEXINGTON SC
29072-4222
US

V. Phone/Fax

Practice location:
  • Phone: 803-227-8000
  • Fax:
Mailing address:
  • Phone: 931-397-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberSC020354
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1158
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: