Healthcare Provider Details

I. General information

NPI: 1902710940
Provider Name (Legal Business Name): ATLANTA HOMEBIRTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 CENTURY BLVD NE STE A
ATLANTA GA
30345-3399
US

IV. Provider business mailing address

1780 CENTURY BLVD NE STE A
ATLANTA GA
30345-3399
US

V. Phone/Fax

Practice location:
  • Phone: 404-474-2770
  • Fax: 470-731-7797
Mailing address:
  • Phone: 404-474-2770
  • Fax: 470-731-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA TAITT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 917-309-1618