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General NPI Number Information
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NPI Number | 1891614053
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Entity Type | Individual
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Provider Name | RICKEA CHANTE TARVER
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Gender | Female
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 709 N MAIN ST
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City | WADLEY
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State | GA
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Zip | 30477-4903
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Country | US
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Telephone | 478-494-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 6949 CLARKS MILL RD
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City | LOUISVILLE
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State | GA
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Zip | 30434-4123
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Country | US
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Telephone | 478-494-3502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN278529
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License Number State | GA
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