MEDICARE: ROSETTA TELLA PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN310295	GA

General Provider Information

NPI Number	:	1093600710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSETTA TELLA PMHNP

Provider Business Mailing Address
First Line	:	3343 PEACHTREE RD NE STE 145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3343 PEACHTREE RD NE STE 145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1427
Country	:	US
Telephone Number	:	678-956-2073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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