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NPI Code Detail

MEDICARE: TELISA MARIE HORNE RN

MEDICARE:   TELISA MARIE HORNE  RN
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
1163W00000XRegistered NurseRN160615GA

General Provider Information

NPI Number : 1922606243
Entity Type Code : Individual
Provider Name (Legal Business Name) : TELISA MARIE HORNE RN
Provider Business Mailing Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-485-9186
Fax Number :
Provider Business Practice Location Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-485-9186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/09/2020

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