Provider Demographics
NPI:1699530360
Name:SMALL, ATARAH CARSHENA
Entity type:Individual
Prefix:
First Name:ATARAH CARSHENA
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATARAH CARSHENA
Other - Middle Name:
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19961 WOODWORTH
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1125
Mailing Address - Country:US
Mailing Address - Phone:248-678-3131
Mailing Address - Fax:
Practice Address - Street 1:19961 WOODWORTH
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1125
Practice Address - Country:US
Practice Address - Phone:248-678-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care