Provider Demographics
NPI:1386520534
Name:RAHMAN, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W 15TH AVE APT A203
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-2434
Mailing Address - Country:US
Mailing Address - Phone:229-417-1918
Mailing Address - Fax:
Practice Address - Street 1:505 W 15TH AVE APT A203
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-2434
Practice Address - Country:US
Practice Address - Phone:229-417-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty