Provider Demographics
NPI:1609435999
Name:PORTER, TABATHIA V
Entity Type:Individual
Prefix:
First Name:TABATHIA
Middle Name:V
Last Name:PORTER
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 1:3219 BLUEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3324
Mailing Address - Country:US
Mailing Address - Phone:614-424-1902
Mailing Address - Fax:
Practice Address - Street 1:895 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2398
Practice Address - Country:US
Practice Address - Phone:614-705-1919
Practice Address - Fax:614-705-1868
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator