Healthcare Provider Details

I. General information

NPI: 1144798463
Provider Name (Legal Business Name): TARMIKA MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 E FAYETTEVILLE RD
RIVERDALE GA
30296-3008
US

IV. Provider business mailing address

1190 E FAYETTEVILLE RD
RIVERDALE GA
30296-3008
US

V. Phone/Fax

Practice location:
  • Phone: 770-374-3578
  • Fax:
Mailing address:
  • Phone: 770-374-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: