MEDICARE: TELESHA HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility		GA

General Provider Information

NPI Number	:	1700540424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TELESHA HARRIS

Provider Business Mailing Address
First Line	:	1056 S CONFEDERATE DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-2829
Country	:	US
Telephone Number	:	478-357-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 UNION CHURCH RD
Second Line	:
City	:	WARTHEN
State	:	GA
Zip	:	31094-3109
Country	:	US
Telephone Number	:	478-357-8777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	10/28/2021

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Directions to “ TELESHA HARRIS ” Practice Location

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