Individual
TAHEISHA RENA DEESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1265 HIGHWAY 54 W STE 305, FAYETTEVILLE, GA 30214-4537
(770) 719-5660
Mailing address
155 BUCKEYE LN, FAYETTEVILLE, GA 30214-1702
(229) 425-8130
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
RN165350
GA
363L00000X
Nurse Practitioner
Primary
RN165350
GA
Other
Enumeration date
07/20/2023
Last updated
02/17/2025
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