Basic Information
| Provider Information | |||||||||
| NPI: | 1932161742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAHTAWI | ||||||||
| FirstName: | JORJETA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | FLETCHER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287321869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286875616 | ||||||||
| FaxNumber: | 8286508076 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 DOCTORS DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287927209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286842587 | ||||||||
| FaxNumber: | 8286518344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 216192 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 200801391 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 696898 | 01 | MA | HARVARD PILGRIM | OTHER | P01320169 | 01 | NC | MEDICARE RR | OTHER | J26039 | 01 | MA | BLUE CROSS | OTHER | 18317 | 01 | NC | BCBSNC | OTHER |