1154374387 NPI number — DR. TAMMY L HAY D.O.

Table of content: DR. TAMMY L HAY D.O. (NPI 1154374387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154374387 NPI number — DR. TAMMY L HAY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAY
Provider First Name:
TAMMY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154374387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4014 CHURCHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-384-4098
Provider Business Mailing Address Fax Number:
704-384-5143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1918 RANDOLPH RD
Provider Second Line Business Practice Location Address:
STE 275
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-384-4098
Provider Business Practice Location Address Fax Number:
704-384-5143
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  97-01391 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: T00488 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89-11279 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com