Provider Demographics
NPI:1194272229
Name:TRUAX, TERESE
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:TRUAX
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:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-8520
Mailing Address - Country:US
Mailing Address - Phone:912-545-9398
Mailing Address - Fax:912-545-2047
Practice Address - Street 1:244 PEACHTREE ST STE A
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0212
Practice Address - Country:US
Practice Address - Phone:912-545-9398
Practice Address - Fax:125-592-0839
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily