Provider Demographics
NPI:1750826434
Name:GILES, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:GILES
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 1:740 FLETCHER ST
Mailing Address - Street 2:SAME
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3249
Mailing Address - Country:US
Mailing Address - Phone:770-748-1500
Mailing Address - Fax:770-749-1094
Practice Address - Street 1:740 FLETCHER ST
Practice Address - Street 2:SAME
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3249
Practice Address - Country:US
Practice Address - Phone:770-748-1500
Practice Address - Fax:770-749-1094
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)