Healthcare Provider Details

I. General information

NPI: 1760106272
Provider Name (Legal Business Name): TESSICA PAISLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 KILLIAN HILL RD SW STE J
LILBURN GA
30047-7601
US

IV. Provider business mailing address

4491 IVY VIEW CT
LOGANVILLE GA
30052-5922
US

V. Phone/Fax

Practice location:
  • Phone: 678-336-9604
  • Fax:
Mailing address:
  • Phone: 914-843-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: