Healthcare Provider Details

I. General information

NPI: 1508732546
Provider Name (Legal Business Name): TARBEAR ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 WENDY BAGWELL PKWY STE 25
HIRAM GA
30141-2885
US

IV. Provider business mailing address

3249 BIRCHHAVEN TRCE
POWDER SPRINGS GA
30127-9038
US

V. Phone/Fax

Practice location:
  • Phone: 678-400-7771
  • Fax:
Mailing address:
  • Phone: 678-400-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TAWANA TARBEART
Title or Position: OWNER
Credential:
Phone: 805-844-2737