Provider Demographics
NPI:1861550865
Name:ALLEN, TAMMY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 VETERAN'S MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE 134-182
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126
Mailing Address - Country:US
Mailing Address - Phone:602-402-2232
Mailing Address - Fax:
Practice Address - Street 1:1400 VETERAN'S MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 134-182
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126
Practice Address - Country:US
Practice Address - Phone:602-402-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144673207Q00000X
CODR.0061967207Q00000X
HIMD-21148207Q00000X
KY48454207Q00000X
NE29002207Q00000X
NH16854207Q00000X
NY303365207Q00000X
SCMMD.36579207Q00000X
TXS9840207Q00000X
WAMD00046605207Q00000X
AZ34101207Q00000X
NMMD2007-0175207Q00000X
ALMD.46242207Q00000X
CAC170329207Q00000X
GA62804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI43338Medicare UPIN