Provider Demographics
NPI:1194999607
Name:ENTREKIN, TERESSA LOUISE (CRT)
Entity type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:LOUISE
Last Name:ENTREKIN
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 HIGHWAY 142 STE D
Mailing Address - Street 2:
Mailing Address - City:NEWBORN
Mailing Address - State:GA
Mailing Address - Zip Code:30056-2020
Mailing Address - Country:US
Mailing Address - Phone:770-784-5410
Mailing Address - Fax:770-788-1828
Practice Address - Street 1:4220 HIGHWAY 142 STE D
Practice Address - Street 2:
Practice Address - City:NEWBORN
Practice Address - State:GA
Practice Address - Zip Code:30056-2020
Practice Address - Country:US
Practice Address - Phone:770-784-5410
Practice Address - Fax:770-788-1828
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies