Healthcare Provider Details

I. General information

NPI: 1942162458
Provider Name (Legal Business Name): TAWANA TARBEART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
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: 805-844-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPHCP043373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: