Provider Demographics
NPI:1043540768
Name:GREENE, TAMARA S (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:S
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5975 SHILOH RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1751
Mailing Address - Country:US
Mailing Address - Phone:770-336-6462
Mailing Address - Fax:770-339-8081
Practice Address - Street 1:5975 SHILOH RD STE 114
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1751
Practice Address - Country:US
Practice Address - Phone:770-336-6462
Practice Address - Fax:770-339-8081
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA679142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology