Basic Information
| Provider Information | |||||||||
| NPI: | 1659920817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | TRESHA | ||||||||
| MiddleName: | DANYELE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11361 AZALEA TRL | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302283230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042452789 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 COLLIER RD NW STE 500 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046052800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN251023 | GA | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | RN251023 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.