Thorn, Tamara Idette
Thorn, Tamara Idette is an sole proprietor health care provider with primary practice located at 3801 Us Highway 17 Ste 500 , Richmond Hill GA 31324-8877. She recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Thorn, Tamara Idette can be contacted via phone (912) 572-0358.Contact Information
Primary practice address
3801 Us Highway 17 Ste 500
Richmond Hill GA 31324-8877
Phone: (912) 572-0358
Fax: (912) 244-9958
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | Georgia | |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | North Carolina | |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 8654 | South Carolina |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C004844 | North Carolina |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | North Carolina | |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | Georgia | |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 005697 | Georgia |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 005697 | Georgia |
Profile Details
| NPI number | 1548320823 |
|---|---|
| LBN Legal business name | Thorn, Tamara Idette |
| Credentials | DMSC DSW LCSW, PA-C |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 9th, 2006 |
| Last updated | Jun 30th, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548320823 | NPPES |
| North Carolina | MEDICAID | 6003179 | |
| North Carolina | Other | 5697 |
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