Provider Demographics
NPI:1760106272
Name:PAISLEY, TESSICA
Entity Type:Individual
Prefix:
First Name:TESSICA
Middle Name:
Last Name:PAISLEY
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 1:4491 IVY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5922
Mailing Address - Country:US
Mailing Address - Phone:914-843-2442
Mailing Address - Fax:
Practice Address - Street 1:1025 KILLIAN HILL RD SW STE J
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7601
Practice Address - Country:US
Practice Address - Phone:678-336-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care