Doctor Name: | MS. TARA LYNN FAVIS |
NPI Number: | 1013279132 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | RN195879 |
Business Practice Address: | 9925 Haynes Bridge Rd Suite 320 Alpharetta, GA - 300228532 |
Business Phone Number: | 7707777495 |
Business Fax Number: | |
Mailing Address: | 2027 Ferry Dr, MARIETTA |
State: | GA |
Postal Code: | 300666252 |
Phone Number: | 6784675179 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2012 |
NPI Last Update Date: | 06/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN195879 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |