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NPI Code Detail

MEDICARE: DR. TARA LYNN BROOKS DDS

MEDICARE: DR. TARA LYNN BROOKS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry11744GA

General Provider Information

NPI Number : 1457497414
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARA LYNN BROOKS DDS
Provider Business Mailing Address
First Line : 1046 RIDGE AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1640
Country : US
Telephone Number : 404-688-1350
Fax Number :
Provider Business Practice Location Address
First Line : 1536 EISENHOWER PKWY
Second Line :
City : MACON
State : GA
Zip : 31206-3130
Country : US
Telephone Number : 478-781-4333
Fax Number : 478-781-4331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 04/20/2016

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