Provider Demographics
NPI:1063525111
Name:PRINCE, TAMI M (MD)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:M
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 OLD AIRPORT RD
Mailing Address - Street 2:APT 284
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4011
Mailing Address - Country:US
Mailing Address - Phone:706-614-0349
Mailing Address - Fax:
Practice Address - Street 1:851 IRELAND AVE
Practice Address - Street 2:ATTN: MCXM-BOC (DENISE HESTER)
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-2722
Practice Address - Country:US
Practice Address - Phone:502-624-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057414207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology