Provider Demographics
NPI:1508991134
Name:SCHORNACK, THERESA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:SCHORNACK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 BANKSTOWN RD
Mailing Address - Street 2:BROOKS
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-1608
Mailing Address - Country:US
Mailing Address - Phone:770-719-5390
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9088
Practice Address - Country:US
Practice Address - Phone:770-389-4543
Practice Address - Fax:770-474-0566
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136627363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics