MEDICARE: MRS. TAUSHA MARIE RHOADES AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN235901	GA

General Provider Information

NPI Number	:	1134691512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAUSHA MARIE RHOADES AGACNP-BC

Provider Business Mailing Address
First Line	:	387 PAPERSHELL DR
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-5348
Country	:	US
Telephone Number	:	814-573-4194
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 S HOUSTON LAKE RD STE 500
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-9094
Country	:	US
Telephone Number	:	478-333-6977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2018
Last Update Date	:	12/22/2018

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