=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942162458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAWANA TARBEART
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5745 WENDY BAGWELL PKWY STE 25
-----------------------------------------------------
City | HIRAM
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30141-2885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-400-7771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3249 BIRCHHAVEN TRCE
-----------------------------------------------------
City | POWDER SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30127-9038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-844-2737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | PHCP043373
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------