Tammy N Henderson, MD
Individual provider Active NPI General Practice Physician · Collinsville, MS
NPI 1801997606 · NPPES record last updated Jun 4, 2013
Key facts
- NPI
- 1801997606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 13886 (MS)
- Practice address
- 9325C Highway 19 N
Collinsville, MS 39325-9219 - Phone
- (601) 626-7108
- Fax
- (601) 626-7975
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13886 | MS | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 13886 | MS | Yes |
Addresses
Primary practice location
9325C Highway 19 N
Collinsville, MS 39325-9219
Mailing address
9325C Highway 19 N
Collinsville, MS 39325-9219
Phone (601) 626-7108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13886 | Other | MS | MS LICENSE NUMBER |
| 00121471 | Medicaid | MS |
Other names
- Dr. Tammy M Nicholas
Other providers in Collinsville, MS
- Kortney Green
- Sue B. Hall
- Oya Weston Hampton
- Laura Renea Hardy
- Edward Daniel Henderson Jr.
- Hometown Hospice Inc
- Gloria J. Jackson
- Kid'S Clinic, PLLC
- Laboratory Corporation of America Holdings
- Laird Hospital, Inc
All providers in Collinsville, MS · General Practice Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.