Provider Demographics
NPI:1457980393
Name:COTHREN, THERESA ANN (TENDER LOVING CARE)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:COTHREN
Suffix:
Gender:F
Credentials:TENDER LOVING CARE
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:COTHREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TENDER LOVING CARE
Mailing Address - Street 1:168 DRURY CT
Mailing Address - Street 2:
Mailing Address - City:HORTENSE
Mailing Address - State:GA
Mailing Address - Zip Code:31543-2906
Mailing Address - Country:US
Mailing Address - Phone:912-778-3541
Mailing Address - Fax:912-778-3541
Practice Address - Street 1:168 DRURY CT
Practice Address - Street 2:
Practice Address - City:HORTENSE
Practice Address - State:GA
Practice Address - Zip Code:31543-2906
Practice Address - Country:US
Practice Address - Phone:912-230-9564
Practice Address - Fax:912-778-3541
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000012775374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty