Provider Demographics
NPI:1821899881
Name:TAVAREZ, ANNY B
Entity type:Individual
Prefix:MRS
First Name:ANNY
Middle Name:B
Last Name:TAVAREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 WINDSOR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7946
Mailing Address - Country:US
Mailing Address - Phone:678-724-9573
Mailing Address - Fax:
Practice Address - Street 1:2599 WINDSOR KNOLL DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7946
Practice Address - Country:US
Practice Address - Phone:678-724-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104100000X, 171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreter
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty