MEDICARE: TAMMY WILBANKS OWENS FNP-C

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	363LF0000X	Family Nurse Practitioner	RN146039NP	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01186539	OTHER	GA	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	459304	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1942279658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY WILBANKS OWENS FNP-C

Provider Business Mailing Address
First Line	:	5136 SHIRLEY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-5115
Country	:	US
Telephone Number	:	706-499-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	5136 SHIRLEY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-5115
Country	:	US
Telephone Number	:	706-499-3086
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	02/15/2016

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