Provider Demographics
NPI:1215696604
Name:TIMBERS, MARY THERESA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:TIMBERS
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 1:191 CAMELLIA WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5525
Mailing Address - Country:US
Mailing Address - Phone:678-878-9941
Mailing Address - Fax:
Practice Address - Street 1:191 CAMELLIA WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5525
Practice Address - Country:US
Practice Address - Phone:678-878-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services