Provider Demographics
NPI:1902602063
Name:INGRAM, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SCALES RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1901
Mailing Address - Country:US
Mailing Address - Phone:770-568-3116
Mailing Address - Fax:
Practice Address - Street 1:1875 OLD ALABAMA RD STE 110
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2261
Practice Address - Country:US
Practice Address - Phone:770-568-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health