Tarhonda Leah Ingram, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN014799 Issued in GA

Practice address

112 Vilseck Road, BLDG. 419-2
Ft. Stewart, GA 31315

Phone

(912) 257-7056

Fax

(912) 257-7055

NPI assigned

Jul 17, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1275940686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "address_2": "US ARMY DENTAL HEALTH ACTIVITY",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-7006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 VILSECK ROAD, BLDG. 419-2",
            "city": "FT. STEWART",
            "state": "GA",
            "postal_code": "31315",
            "telephone_number": "912-257-7056",
            "fax_number": "912-257-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1061 Harmon Ave",
            "address_2": "US Army Dental Health Activity",
            "address_purpose": "LOCATION",
            "city": "Fort Stewart",
            "state": "GA",
            "postal_code": "313145641",
            "country_code": "US",
            "telephone_number": "912-435-7006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "TARHONDA",
        "middle_name": "LEAH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-17",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nordwanna Venite-Lubin Hysons, LPM
• Adebisi Z Ibrahim, DIETITIAN
• Daniel Idelkope, MD
• Mitchel Ideue, PT
• Richard Ken Inae, M.D.
• Dynisha Ivy, PHARMACIST
• Jacer Corporation
• Amelia Jackson
• Erica Jackson, PTA
• Karen Jackson, R.N

• Dentist in Ft. Stewart, GA
• Providers in Ft. Stewart, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.