MEDICARE: TAMMY DIONNE PERSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	007576	GA

General Provider Information

NPI Number	:	1871137497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY DIONNE PERSON LPC

Provider Business Mailing Address
First Line	:	6718 BRIDGE WAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1370
Country	:	US
Telephone Number	:	762-359-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 BRIDGE WAY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1370
Country	:	US
Telephone Number	:	762-359-5731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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