Provider Demographics
NPI:1487708525
Name:ANDERSON, TANYA SAVAGE (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:SAVAGE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:RENEE
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:114 SINGING HILLS CV
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-8416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703B FARMER ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2319
Practice Address - Country:US
Practice Address - Phone:601-437-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122761Medicaid
MS0122761Medicaid