Provider Demographics
NPI:1073965844
Name:TIERNEY, CAITLIN MEHALICK (DO)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MEHALICK
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:A
Other - Last Name:MEHALICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:
Practice Address - Street 1:804 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4416
Practice Address - Country:US
Practice Address - Phone:770-834-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077959208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics