Provider Demographics
NPI:1598717639
Name:TARR, CHAD DONALD (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DONALD
Last Name:TARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1860
Mailing Address - Country:US
Mailing Address - Phone:478-240-2000
Mailing Address - Fax:478-240-2377
Practice Address - Street 1:610 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1860
Practice Address - Country:US
Practice Address - Phone:478-240-2000
Practice Address - Fax:478-240-2377
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055272A207P00000X
KY44183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA170444001AOtherPEACH STATE HEALTH PLAN
GA170444001AMedicaid
GAN288744OtherWELLCARE
GA10064517OtherAMERIGROUP
SCG49710Medicaid
GA967532OtherBLUE CROSS BLUE SHIELD
KYP00928404OtherMEDICARE RAILROAD
KY7100173340Medicaid
KY7100173340Medicaid
GA967532OtherBLUE CROSS BLUE SHIELD
GA93BFBBCMedicare PIN
GA10064517OtherAMERIGROUP
GAN288744OtherWELLCARE