Provider Demographics
NPI:1689214827
Name:AYERS, TARA NICOLE TAYLOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE TAYLOR
Last Name:AYERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NEW ZION RD SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7934
Mailing Address - Country:US
Mailing Address - Phone:770-480-2414
Mailing Address - Fax:
Practice Address - Street 1:1365 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3857
Practice Address - Country:US
Practice Address - Phone:706-270-0850
Practice Address - Fax:706-270-0852
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0315031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist