Individual provider Active NPI

Tara Phelps Gulsby, NP-C

  • Nurse Practitioner
  • Loganville, GA
National Provider Identifier
1568897767
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN209319 Issued in GA
Practice address
3869 Highway 81
Loganville, GA 30052-3918
Phone
(678) 635-8650
NPI assigned
Sep 6, 2013
Last updated
Aug 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN209319 GA Primary
Family Nurse Practitioner 363LF0000X RN209319 GA

Addresses

Primary practice location

3869 Highway 81
Loganville, GA 30052-3918

Mailing address

1001 Summit Blvd Ste 200
Brookhaven, GA 30319-6410
Phone (770) 989-1668

Other practice location 1

340 N Milledge Ave Ste B
Athens, GA 30601-3806
Phone (706) 548-0008

Other identifiers 1

IdentifierTypeStateIssuer
003143806GMedicaidGA

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140227002188 GA Practitioner - Nurse Practitioner 9234369885 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Providers LLCGroup PAC ID 9830082825, 526 clinicians

Practice addresses (Care Compare)

3869 Hwy 81
Loganville, GA 30052-3918
Phone (678) 635-8650

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN209319GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aga Professional Services, LLC CurrentSince Feb 1, 2018 Accepting new patients
Aga, LLC CurrentSince Feb 1, 2018 Accepting new patients
Aga Clinical Services, LLC CurrentSince Feb 12, 2020 Accepting new patients
Piedmont Providers LLC CurrentSince Aug 22, 2022 Accepting new patients

Locations

340 N Milledge Ave
Ste B
Athens, GA 30601
Phone (706) 548-0008

1984 Peachtree Rd NW
Ste 300
Atlanta, GA 30309
Phone (404) 367-3210

2727 Paces Ferry Rd SE
Ste 1-1100
Atlanta, GA 30339
Phone (470) 271-3421

218 Hospital Dr
#C
Blairsville, GA 30512
Phone (706) 400-5668

3869 Highway 81
Loganville, GA 30052
Phone (678) 635-8280

2520 Windy Hill Rd SE
Ste 102
Marietta, GA 30067
Phone (770) 612-8165

488 Kennesaw Ave NW
Ste 200
Marietta, GA 30060
Phone (770) 427-3075

1305 Jennings Mill Rd
Ste 260
Watkinsville, GA 30677
Phone (706) 548-0008

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d88010de-d791-42d4-b72d-513f9afc5ed1/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1568897767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SUMMIT BLVD STE 200",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303196410",
            "telephone_number": "770-989-1668",
            "fax_number": "678-388-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3869 HIGHWAY 81",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523918",
            "telephone_number": "678-635-8650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 N Milledge Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306013806",
            "country_code": "US",
            "telephone_number": "706-548-0008",
            "fax_number": "706-369-9673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULSBY",
        "first_name": "TARA",
        "middle_name": "PHELPS",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-06",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN209319",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN209319",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003143806G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

Verify at the official NPI Registry.