Provider Demographics
NPI:1487362000
Name:MADRIC, TIARA C (BD,PD,)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:C
Last Name:MADRIC
Suffix:
Gender:F
Credentials:BD,PD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 EVONSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4178
Mailing Address - Country:US
Mailing Address - Phone:404-558-7666
Mailing Address - Fax:
Practice Address - Street 1:129 EVONSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4178
Practice Address - Country:US
Practice Address - Phone:404-558-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula