Healthcare Provider Details

I. General information

NPI: 1922961010
Provider Name (Legal Business Name): TARA YOUSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 10TH ST
COLUMBUS GA
31906-3404
US

IV. Provider business mailing address

3310 10TH ST
COLUMBUS GA
31906-3404
US

V. Phone/Fax

Practice location:
  • Phone: 706-573-7312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0000042051
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: