Healthcare Provider Details

I. General information

NPI: 1821472416
Provider Name (Legal Business Name): TABARI RASHID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 BELLVUE DR SE
MARIETTA GA
30060-2414
US

IV. Provider business mailing address

284 BELLVUE DR SE
MARIETTA GA
30060-2414
US

V. Phone/Fax

Practice location:
  • Phone: 470-216-9274
  • Fax:
Mailing address:
  • Phone: 470-216-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: