Provider Demographics
NPI:1922999028
Name:THOMPSON, TAMARA W
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:W
Last Name:THOMPSON
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 1:309 W PINE STREET
Mailing Address - Street 2:TAMARA.THOMPSON40@YAHOO.COM
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-2821
Mailing Address - Country:US
Mailing Address - Phone:704-756-6700
Mailing Address - Fax:
Practice Address - Street 1:309 W PINE ST
Practice Address - Street 2:TBROADWAY4045@GMAIL.COM
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:704-756-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home