Provider Demographics
NPI:1174815138
Name:BARTON, TARA (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BARTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1503 PROFESSIONAL CT
Practice Address - Street 2:SUITE 100
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2566
Practice Address - Country:US
Practice Address - Phone:706-281-2121
Practice Address - Fax:706-378-1204
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6089363A00000X
TN2573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant