Healthcare Provider Details

I. General information

NPI: 1629251822
Provider Name (Legal Business Name): STEVEN R TARASZKA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 WEST SPRING ST
MONROE GA
30655
US

IV. Provider business mailing address

924 WEST SPRING ST
MONROE GA
30655
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-4455
  • Fax: 770-267-7495
Mailing address:
  • Phone: 770-267-4455
  • Fax: 770-267-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2081P2900X
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number208VP0014X
License Number State

VIII. Authorized Official

Name: STEVEN ROBERT TARASZKA
Title or Position: PRESIDENT
Credential: MD
Phone: 770-267-4455