Provider Demographics
NPI:1265897540
Name:TELESFORD, JEYSIRINE
Entity type:Individual
Prefix:MRS
First Name:JEYSIRINE
Middle Name:
Last Name:TELESFORD
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 1:290 KESTREL CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7652
Mailing Address - Country:US
Mailing Address - Phone:770-385-7750
Mailing Address - Fax:770-385-7750
Practice Address - Street 1:290 KESTREL CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7652
Practice Address - Country:US
Practice Address - Phone:770-385-7750
Practice Address - Fax:770-385-7750
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherMEDICAID, UNITED HEALTH , HUMANA