Provider Information for 1063001378
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Ms. TAMARA ELIZABETH CHURCH LISW-CP
Sex: Female
NPI: 1063001378
Last Updated: 2024-09-13
Certification Date: 2024-09-13
Certification Date: 2024-09-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063001378 | ||||||||
| Enumeration Date | 2021-01-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 740013 ATLANTA, GA 30374-0013 United States Phone: 312-733-9730 | Fax: | ||||||||
| Primary Practice Address | 1135 GREGG HWY NW AIKEN, SC 29801-6341 United States Phone: 619-373-5121 | Fax: | ||||||||
| Secondary Practice Address(es) | 2000 PARK ST STE 101-1355 | ||||||||
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