Provider Demographics
NPI:1386040426
Name:TAGTA, LLC
Entity Type:Organization
Organization Name:TAGTA, LLC
Other - Org Name:GBHP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGTACIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-431-2354
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6303
Mailing Address - Country:US
Mailing Address - Phone:770-431-2354
Mailing Address - Fax:770-436-7143
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:SUITE 115
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:770-431-2354
Practice Address - Fax:770-436-7143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAGTA,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002588261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center