Basic Information
| Provider Information | |||||||||
| NPI: | 1508877325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURTNEY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 EMERY HWY | ||||||||
| Address2: | RIVER EDGE BEHAVIORAL HEALTH | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312173692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4788037631 | ||||||||
| FaxNumber: | 4788038596 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 EMERY HWY | ||||||||
| Address2: | RIVER EDGE BEHAVIORAL HEALTH | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312173692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4788037631 | ||||||||
| FaxNumber: | 4788038596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 027043 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 28043 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.