Provider Demographics
NPI:1164986501
Name:PASHA, TARA HUDSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:HUDSON
Last Name:PASHA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 MARKETPLACE BLVD # 130-229
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:678-350-3536
Mailing Address - Fax:
Practice Address - Street 1:480 JOHN WESLEY DOBBS AVE NE UNIT 180
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5326
Practice Address - Country:US
Practice Address - Phone:678-635-9832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist