Provider Demographics
NPI:1750098984
Name:JONES WILDER, TERESA ANN (CD, PCD, CBC,RPYT85)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:JONES WILDER
Suffix:
Gender:F
Credentials:CD, PCD, CBC,RPYT85
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 POINTE SOUTH PKWY APT 1903
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4314
Mailing Address - Country:US
Mailing Address - Phone:404-713-5807
Mailing Address - Fax:
Practice Address - Street 1:772 POINTE SOUTH PKWY APT 1903
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-4314
Practice Address - Country:US
Practice Address - Phone:404-713-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach