Healthcare Provider Details

I. General information

NPI: 1598707705
Provider Name (Legal Business Name): TARA ELIZABETH SCHAFER DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE GC-1012
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2716
  • Fax: 706-721-6778
Mailing address:
  • Phone: 706-721-2716
  • Fax: 706-721-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDNES000291
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN011452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: