Provider Demographics
NPI:1093209637
Name:OWENS, NEKELSHA TIARA
Entity Type:Individual
Prefix:
First Name:NEKELSHA
Middle Name:TIARA
Last Name:OWENS
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 1:6200 BRADLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3078
Mailing Address - Country:US
Mailing Address - Phone:706-221-2024
Mailing Address - Fax:
Practice Address - Street 1:6200 BRADLEY PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3078
Practice Address - Country:US
Practice Address - Phone:706-221-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health