Provider Demographics
NPI:1245537562
Name:GODFREY, TAMARA N (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:N
Last Name:GODFREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1742
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1742
Mailing Address - Country:US
Mailing Address - Phone:678-235-8767
Mailing Address - Fax:855-740-3001
Practice Address - Street 1:111 N MCDONOUGH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3317
Practice Address - Country:US
Practice Address - Phone:678-235-8767
Practice Address - Fax:855-740-3001
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003307103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106375BMedicaid
GA003106375CMedicaid