Provider Demographics
NPI:1093116410
Name:WALCOT-CEESAY, THERESA HANNAH (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:HANNAH
Last Name:WALCOT-CEESAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4082
Mailing Address - Country:US
Mailing Address - Phone:404-859-3216
Mailing Address - Fax:
Practice Address - Street 1:5734 WINCHESTER PL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4082
Practice Address - Country:US
Practice Address - Phone:404-859-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193249163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse