MEDICARE: TARA DOZIER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2024000757	GA

General Provider Information

NPI Number	:	1760259899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA DOZIER

Provider Business Mailing Address
First Line	:	3995 S COBB DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6342
Country	:	US
Telephone Number	:	404-437-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 104
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2655
Country	:	US
Telephone Number	:	770-573-9546
Fax Number	:

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

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	02/22/2024

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Directions to “ TARA DOZIER ” Practice Location

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