Tami Lynn Backstrom, L.M.T
Individual provider Active NPI Contractor · Douglasville, GA
NPI 1902135205 · NPPES record last updated Dec 15, 2009
Key facts
- NPI
- 1902135205
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- MT005428 (GA)
- Practice address
- 7193 Douglas Blvd Ste 103a
Douglasville, GA 30135-1540 - Phone
- (770) 845-4407
- NPI assigned
- Dec 15, 2009
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT005428 | GA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | MT005428 | GA | Yes |
Addresses
Primary practice location
7193 Douglas Blvd Ste 103a
Douglasville, GA 30135-1540
Mailing address
7193 Douglas Blvd Ste 103a
Douglasville, GA 30135-1540
Phone (770) 845-4407
Other providers in Douglasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2009. 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.