| Tara Pettit Deloach Llc | |
|
930 Stevens Creek Rd Augusta GA 30907-3200 | |
| (706) 343-3661 | |
| Not Available |
| Full Name | Tara Pettit Deloach Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 930 Stevens Creek Rd, Augusta, Georgia |
| Authorized Official Name and Position | Tara Pettit Deloach (OWNER) |
| Authorized Official Contact | 7063433661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Pettit Deloach Llc 930 Stevens Creek Rd Augusta GA 30907-3200 Ph: (706) 343-3661 | Tara Pettit Deloach Llc 930 Stevens Creek Rd Augusta GA 30907-3200 Ph: (706) 343-3661 |
| NPI Number | 1124897145 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 01/02/2024 |
| Certification Date | 01/02/2024 |
| Medicare PECOS PAC ID | 2466896238 |
|---|---|
| Medicare Enrollment ID | O20240220002952 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124897145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tara Pettit Deloach |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790002947 PECOS PAC ID: 3375987142 Enrollment ID: I20240220003175 |
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