Provider Demographics
NPI:1598833121
Name:THORNBERRY KIDNEY, TAMI M (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMI
Middle Name:M
Last Name:THORNBERRY KIDNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 JUNIPER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-554-4552
Mailing Address - Fax:912-554-0343
Practice Address - Street 1:165 JUNIPER CIRCLE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-554-4552
Practice Address - Fax:912-554-0343
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0113511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000654783DMedicaid