Provider Demographics
NPI:1891517470
Name:DEVEREAUX, TARMESHA
Entity type:Individual
Prefix:
First Name:TARMESHA
Middle Name:
Last Name:DEVEREAUX
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 1:250 LAWRENCE RD NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9696
Mailing Address - Country:US
Mailing Address - Phone:478-234-6354
Mailing Address - Fax:
Practice Address - Street 1:250 LAWRENCE RD NW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9696
Practice Address - Country:US
Practice Address - Phone:478-234-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator