Provider Demographics
NPI:1447989793
Name:TARVER, ROSALIND R
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:R
Last Name:TARVER
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 1:1773 MCCLELLAND AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-1671
Mailing Address - Country:US
Mailing Address - Phone:404-914-2772
Mailing Address - Fax:
Practice Address - Street 1:1773 MCCLELLAND AVE APT 10
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-1671
Practice Address - Country:US
Practice Address - Phone:404-914-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO096115224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty