Provider Demographics
NPI:1205426566
Name:EARLY, TEMEKA NICOLE
Entity type:Individual
Prefix:
First Name:TEMEKA
Middle Name:NICOLE
Last Name:EARLY
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 1:15 SIDNEY DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2936
Mailing Address - Country:US
Mailing Address - Phone:912-441-3763
Mailing Address - Fax:
Practice Address - Street 1:15 SIDNEY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2936
Practice Address - Country:US
Practice Address - Phone:912-441-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH010027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health