Provider Demographics
NPI:1922606243
Name:HORNE, TELISA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TELISA
Middle Name:MARIE
Last Name:HORNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TECHNOLOGY CT SE STE E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5203
Mailing Address - Country:US
Mailing Address - Phone:770-485-9186
Mailing Address - Fax:
Practice Address - Street 1:200 TECHNOLOGY CT SE STE E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5203
Practice Address - Country:US
Practice Address - Phone:770-485-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse