Individual
MRS. TARA PHELPS GULSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3869 HIGHWAY 81, LOGANVILLE, GA 30052-3918
(678) 635-8650
Mailing address
1001 SUMMIT BLVD STE 200, BROOKHAVEN, GA 30319-6410
(770) 989-1668
(678) 388-1759
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN209319
GA
363LF0000X
Family Nurse Practitioner
RN209319
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003143806G
—
GA
Enumeration date
09/06/2013
Last updated
08/09/2022
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