Provider Demographics
NPI:1881911089
Name:TARR MEDICAL PC
Entity type:Organization
Organization Name:TARR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:BEDFORD
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-346-3487
Mailing Address - Street 1:1123 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1729
Mailing Address - Country:US
Mailing Address - Phone:404-346-3487
Mailing Address - Fax:404-349-8628
Practice Address - Street 1:1123 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1729
Practice Address - Country:US
Practice Address - Phone:404-346-3487
Practice Address - Fax:404-349-8628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARR MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-27
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN
GA=========OtherEIN