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General NPI Number Information
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NPI Number | 1407104623
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Entity Type | Individual
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Provider Name | TAMMY S HARRIS
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 163 BUSINESS PARK DR STE 11
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City | LEBANON
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State | TN
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Zip | 37090-1241
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Country | US
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Telephone | 615-443-4445
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Fax | 615-443-4448
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Provider Business Mailing Address
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Address Line | 405 BRIDGE AVE APT 1
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City | MURFREESBORO
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State | TN
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Zip | 37129-3457
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Country | US
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Telephone | 615-631-0031
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 196
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License Number State | TN
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