Provider Demographics
NPI:1205419074
Name:PRESLEY, TIMOTHY SHAY
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SHAY
Last Name:PRESLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 PEACHTREE ST NE STE 570
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1244
Mailing Address - Country:US
Mailing Address - Phone:404-664-6475
Mailing Address - Fax:
Practice Address - Street 1:2570 BEDFORD PLACE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-3121
Practice Address - Country:US
Practice Address - Phone:404-664-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028844403376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide