Healthcare Provider Details

I. General information

NPI: 1952833543
Provider Name (Legal Business Name): TARA ELIZABETH CHANEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 W BANKHEAD HWY
VILLA RICA GA
30180-1501
US

IV. Provider business mailing address

736 W BANKHEAD HWY
VILLA RICA GA
30180-1501
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00720700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN295563
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: