Provider Demographics
NPI:1467021493
Name:RAWLS, TARA DENISE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DENISE
Last Name:RAWLS
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 1:1507 HARDY ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4978
Mailing Address - Country:US
Mailing Address - Phone:601-602-4793
Mailing Address - Fax:
Practice Address - Street 1:1507 HARDY ST STE 207
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4978
Practice Address - Country:US
Practice Address - Phone:601-602-4793
Practice Address - Fax:601-602-4905
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care