Provider Demographics
NPI:1740544105
Name:COMRIE, THERESA (RN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:COMRIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 BAHIA MAR CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1603
Mailing Address - Country:US
Mailing Address - Phone:770-823-2403
Mailing Address - Fax:
Practice Address - Street 1:5656 BAHIA MAR CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1603
Practice Address - Country:US
Practice Address - Phone:770-823-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-30
Last Update Date:2012-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN091927163W00000X, 163WA0400X, 163WG0600X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WG0600XNursing Service ProvidersRegistered NurseGerontology