Provider Demographics
NPI:1427314210
Name:FALES, TARA MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MITCHELL
Last Name:FALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:DAWN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1948 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0642
Mailing Address - Country:US
Mailing Address - Phone:256-739-1575
Mailing Address - Fax:256-255-1492
Practice Address - Street 1:1948 AL HIGHWAY 157
Practice Address - Street 2:SUITE 360
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0642
Practice Address - Country:US
Practice Address - Phone:256-739-1575
Practice Address - Fax:256-255-1492
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.34006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program