Provider Demographics
NPI:1467253682
Name:OWENS, TIESHA
Entity type:Individual
Prefix:
First Name:TIESHA
Middle Name:
Last Name:OWENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 HILLMAN RD NE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30631-1903
Mailing Address - Country:US
Mailing Address - Phone:706-401-3665
Mailing Address - Fax:706-401-3665
Practice Address - Street 1:4105 HILLMAN RD NE
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:GA
Practice Address - Zip Code:30631-1903
Practice Address - Country:US
Practice Address - Phone:706-401-3665
Practice Address - Fax:706-401-3665
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula