Provider Demographics
NPI:1972249035
Name:TARD, TERESA M
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:TARD
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 1:72 PARADISE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5235
Mailing Address - Country:US
Mailing Address - Phone:404-345-4652
Mailing Address - Fax:
Practice Address - Street 1:72 PARADISE CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5235
Practice Address - Country:US
Practice Address - Phone:404-345-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide