Provider Demographics
NPI:1508407354
Name:PAULK, TABITHA
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:PAULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 GUS PAULK RD
Mailing Address - Street 2:
Mailing Address - City:AMBROSE
Mailing Address - State:GA
Mailing Address - Zip Code:31512-3408
Mailing Address - Country:US
Mailing Address - Phone:912-327-4967
Mailing Address - Fax:
Practice Address - Street 1:1095 GUS PAULK RD
Practice Address - Street 2:
Practice Address - City:AMBROSE
Practice Address - State:GA
Practice Address - Zip Code:31512-3408
Practice Address - Country:US
Practice Address - Phone:912-327-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide