| NPI Number | 1306005202 |
| Provider Name | Tambrea Toylett Ellison |
| Credential | |
| Specialization | |
| Medical School Name | Medical College Of Georgia School Of Medicine |
| Graduation Year | 2008 |
| Gender | F |
| Entity Type | Individual |
| PAC ID by PECOS | 6507016243 |
| Professional Enrollment ID | I20130624000446 |
| Enumeration Date | 06/05/2008 |
| Last Update Date | 12/07/2016 |
| Business Practice address |
900 EAGLES LANDING PKWY, Stockbridge, 30281-7343 Georgia View on Google Map |
| Business Practice phone | 770-997-0600 |
| Business Practice fax | |
| Mailing address |
1185 COLLIER RD NW, Atlanta, 30318-8232 Georgia View on Google Map |
| Other phone | 706-210-8027 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Stockbridge, Georgia
Sgmc Berrien Campus
Tift Regional Medical Center
Medical College Of Georgia School Of Medicine
2008
| Field Name | Field Value |
|---|---|
| NPI | 1306005202 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
|
| Is Sole Proprietor | N |
Indicate whether provider is a sole proprietor.
|
|
| Provider Last Name (Legal Name) | Ellison |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Tambrea |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | M.D. |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 1185 COLLIER RD NW |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Atlanta |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Georgia |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 30318-8232 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 706-210-8027 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 900 EAGLES LANDING PKWY |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | Stockbridge |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Georgia |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 30281-7343 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 770-997-0600 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 06/05/2008 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 12/07/2016 |
| The date that a record was last updated or changed. | |
| Provider Gender Code | F |
| The code designating the provider's gender if the provider is a person. | |
| Provider Gender | Female |
| The provider's gender if the provider is a person. | |
| Healthcare Provider Taxonomy Code #1 | 207R00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Healthcare Provider Taxonomy #1 | |
| Provider License Number 1 | LL30874 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 1 | SC |
| Provider License Number State Code #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
|
|
| Healthcare Provider Taxonomy Code #2 | 208VP0014X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| Healthcare Provider Taxonomy #2 | |
| Provider License Number 2 | 69187 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 2 | GA |
| Provider License Number State Code #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
|
|
| Healthcare Provider Taxonomy Code #3 | 208VP0000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies. |
| Healthcare Provider Taxonomy #3 | |
| Provider License Number 3 | 69187 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 3 | GA |
| Provider License Number State Code #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
|
|
| Healthcare Provider Taxonomy Code #4 | 208100000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices. |
| Healthcare Provider Taxonomy #4 | |
| Provider License Number 4 | 69187 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 4 | GA |
| Provider License Number State Code #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | Y |
Primary Taxonomy:
|
|
| Healthcare Provider Taxonomy Code #5 | 2081P2900X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Healthcare Provider Taxonomy #5 | |
| Provider License Number 5 | 69187 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 5 | GA |
| Provider License Number State Code #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | N |
Primary Taxonomy:
|
