Provider Demographics
NPI:1861235988
Name:TATE, DARLENE FAY
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:FAY
Last Name:TATE
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 1:477 N MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2323
Mailing Address - Country:US
Mailing Address - Phone:404-259-4276
Mailing Address - Fax:
Practice Address - Street 1:477 N MARBLE ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2323
Practice Address - Country:US
Practice Address - Phone:404-259-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide