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General NPI Number Information
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NPI Number | 1033768833
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Entity Type | Individual
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Provider Name | TAMALA BOOKER MIDDLETON ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 106 E BROAD ST
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City | SAVANNAH
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State | GA
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Zip | 31401-2917
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Country | US
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Telephone | 912-464-5187
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Fax | 912-527-1099
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Provider Business Mailing Address
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Address Line | 4002 CAMPBELL ST
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City | SAVANNAH
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State | GA
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Zip | 31405-2927
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Country | US
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Telephone | 912-220-0059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 127388
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 127388
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License Number State | GA
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