Provider Demographics
NPI:1790148922
Name:WIMBERLY, TCHELYNDA BRIANNE
Entity Type:Individual
Prefix:
First Name:TCHELYNDA
Middle Name:BRIANNE
Last Name:WIMBERLY
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 1:3713 RIO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-5925
Mailing Address - Country:US
Mailing Address - Phone:706-496-3010
Mailing Address - Fax:
Practice Address - Street 1:3713 RIO RIDGE DR
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-5925
Practice Address - Country:US
Practice Address - Phone:706-496-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81-2080872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health