Provider Demographics
NPI:1396822102
Name:RONEY, TARA SMITH (AUD)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:SMITH
Last Name:RONEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 ARMOUR RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5095
Mailing Address - Country:US
Mailing Address - Phone:706-571-8877
Mailing Address - Fax:706-571-9411
Practice Address - Street 1:4401 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5096
Practice Address - Country:US
Practice Address - Phone:706-571-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003703231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52703539-002OtherBLUE CROSS BLUE SHIELD
64BCBNSMedicare ID - Type UnspecifiedGROUP NUMBER
Q62858Medicare UPIN