Provider Demographics
NPI:1386888352
Name:FRIEDMAN, TARA (MED)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 GLEN OAKS LN NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8200
Mailing Address - Country:US
Mailing Address - Phone:404-550-1944
Mailing Address - Fax:678-974-2464
Practice Address - Street 1:6345 GLEN OAKS LN NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-8200
Practice Address - Country:US
Practice Address - Phone:404-550-1944
Practice Address - Fax:678-974-2464
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA460266080BMedicaid