Provider Demographics
NPI:1720315724
Name:DIGGS, TEQUESTA VENIA
Entity Type:Individual
Prefix:MS
First Name:TEQUESTA
Middle Name:VENIA
Last Name:DIGGS
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 1:713 VARNEDOE ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7245
Mailing Address - Country:US
Mailing Address - Phone:229-236-1013
Mailing Address - Fax:229-226-6353
Practice Address - Street 1:7544 METCALF RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-8638
Practice Address - Country:US
Practice Address - Phone:229-236-1013
Practice Address - Fax:229-226-6353
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist