Individual
TARA BUCKHALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1150 LAKE HEARN DRIVE, ATLANTA, GA 30342
(954) 594-6520
Mailing address
4263 GLENGARY DRIVE NE, ATLANTA, GA 30342
(954) 594-6520
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN212433
GA
Other
Enumeration date
10/20/2020
Last updated
10/01/2024
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