Provider Demographics
NPI:1710868112
Name:TOLBERT, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:TOLBERT
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 1:178 US HIGHWAY 321 BYP N
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-9251
Mailing Address - Country:US
Mailing Address - Phone:803-635-2335
Mailing Address - Fax:
Practice Address - Street 1:178 US HIGHWAY 321 BYP N
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-9251
Practice Address - Country:US
Practice Address - Phone:803-635-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist