Healthcare Provider Details

I. General information

NPI: 1821986746
Provider Name (Legal Business Name): TAMARA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 NORMANDY COB DR
MURFREESBORO TN
37129-2380
US

IV. Provider business mailing address

1693 CARATOKE HWY
MOYOCK NC
27958-8725
US

V. Phone/Fax

Practice location:
  • Phone: 252-435-1665
  • Fax:
Mailing address:
  • Phone: 252-435-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: