Provider Demographics
NPI:1033604962
Name:HUMPHRIES, TREQUIA
Entity Type:Individual
Prefix:
First Name:TREQUIA
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 QUAILS LAKE VILLAGE LN APT F
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5341
Mailing Address - Country:US
Mailing Address - Phone:470-255-8171
Mailing Address - Fax:
Practice Address - Street 1:3222 QUAILS LAKE VILLAGE LN APT F
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5341
Practice Address - Country:US
Practice Address - Phone:470-255-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula