Provider Demographics
NPI:1083489777
Name:TATARSKY, MADELINE BEVINS (NP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:BEVINS
Last Name:TATARSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3177 SAYBROOK DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2439
Mailing Address - Country:US
Mailing Address - Phone:678-576-0026
Mailing Address - Fax:
Practice Address - Street 1:1801 PEACHTREE ST NE STE 145
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1895
Practice Address - Country:US
Practice Address - Phone:770-274-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily