Provider Demographics
NPI:1730976721
Name:ALDENTALER, TASHA MAE (RN)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:MAE
Last Name:ALDENTALER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:MAE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-6333
Mailing Address - Country:US
Mailing Address - Phone:678-687-0141
Mailing Address - Fax:
Practice Address - Street 1:44 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-6333
Practice Address - Country:US
Practice Address - Phone:678-687-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2773942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry