Provider Demographics
NPI:1548087240
Name:BOBB, TAMIYA
Entity type:Individual
Prefix:
First Name:TAMIYA
Middle Name:
Last Name:BOBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 PARKWAY NORTH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1226
Mailing Address - Country:US
Mailing Address - Phone:404-388-3909
Mailing Address - Fax:678-712-1945
Practice Address - Street 1:5975 PKWY NORTH BLVD STE D
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8255
Practice Address - Country:US
Practice Address - Phone:470-394-5618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health