Provider Demographics
NPI:1447457965
Name:PAVEY, TAMMI B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:B
Last Name:PAVEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:L
Other - Last Name:BALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2050 WALTON WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4163
Mailing Address - Country:US
Mailing Address - Phone:706-267-0793
Mailing Address - Fax:706-434-1346
Practice Address - Street 1:2050 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-2305
Practice Address - Country:US
Practice Address - Phone:706-434-1590
Practice Address - Fax:706-434-1346
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3053207RE0101X
GA003053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3053OtherGEORGIA LICENSE