Provider Demographics
NPI:1588463186
Name:TACKETT, BREANNA RAY (BSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RAY
Last Name:TACKETT
Suffix:
Gender:
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 OLIVER WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5822
Mailing Address - Country:US
Mailing Address - Phone:706-913-7556
Mailing Address - Fax:
Practice Address - Street 1:197 CURTIS PKWY NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2063
Practice Address - Country:US
Practice Address - Phone:706-463-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker