Healthcare Provider Details

I. General information

NPI: 1366066607
Provider Name (Legal Business Name): TARAYA BARTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PHOENIX BLVD STE 400
ATLANTA GA
30349-5560
US

IV. Provider business mailing address

1800 PHOENIX BLVD STE 400
ATLANTA GA
30349-5560
US

V. Phone/Fax

Practice location:
  • Phone: 888-329-4535
  • Fax:
Mailing address:
  • Phone: 888-329-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA000258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: