1598717639 NPI number — CHAD DONALD TARR MD

Table of content: JOHN F WALLING JR. DO (NPI 1073579512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598717639 NPI number — CHAD DONALD TARR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARR
Provider First Name:
CHAD
Provider Middle Name:
DONALD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598717639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 SPARTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDERSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31082-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-240-2000
Provider Business Mailing Address Fax Number:
478-240-2377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 SPARTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31082-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-240-2000
Provider Business Practice Location Address Fax Number:
478-240-2377
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  01055272A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 44183 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 49710 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N288744 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 170444001A . This is a "PEACH STATE HEALTH PLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 967532 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10064517 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 170444001A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00928404 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100173340 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: G49710 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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