Healthcare Provider Details

I. General information

NPI: 1891181061
Provider Name (Legal Business Name): DINA TAAREA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 S LEE ST STE 101
BUFORD GA
30518-3710
US

IV. Provider business mailing address

4271 S LEE ST STE 101
BUFORD GA
30518-3710
US

V. Phone/Fax

Practice location:
  • Phone: 678-765-8160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number99801
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99801
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number320101
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: