Healthcare Provider Details

I. General information

NPI: 1306580402
Provider Name (Legal Business Name): TARA OPARA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 OZARK TRL
BUFORD GA
30518-9225
US

IV. Provider business mailing address

4186 OZARK TRL
BUFORD GA
30518-9225
US

V. Phone/Fax

Practice location:
  • Phone: 678-232-2968
  • Fax:
Mailing address:
  • Phone: 678-232-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW010555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: