Provider Demographics
NPI:1679182901
Name:SPRADLEY, TAMISHA T
Entity type:Individual
Prefix:
First Name:TAMISHA
Middle Name:T
Last Name:SPRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMEISHA
Other - Middle Name:T
Other - Last Name:SPRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1716 QUEEN VICTORIA CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3656
Mailing Address - Country:US
Mailing Address - Phone:678-834-3148
Mailing Address - Fax:
Practice Address - Street 1:1716 QUEEN VICTORIA CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3656
Practice Address - Country:US
Practice Address - Phone:678-834-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00028840194374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide