Provider Demographics
NPI:1134691512
Name:RHOADES, TAUSHA MARIE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TAUSHA
Middle Name:MARIE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 PAPERSHELL DR
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-5348
Mailing Address - Country:US
Mailing Address - Phone:814-573-4194
Mailing Address - Fax:
Practice Address - Street 1:623 S HOUSTON LAKE RD STE 500
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9094
Practice Address - Country:US
Practice Address - Phone:478-333-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner