MEDICARE: DR. TERESA GREAR LCSW

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	1041C0700X	Clinical Social Worker	001672	GA

General Provider Information

NPI Number	:	1144558982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA GREAR LCSW

Provider Business Mailing Address
First Line	:	615 ROSWELL ST NE
Second Line	:	SUITE 1000
City	:	MARIETTA
State	:	GA
Zip	:	30060-2196
Country	:	US
Telephone Number	:	770-795-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ROSWELL ST NE
Second Line	:	SUITE 1000
City	:	MARIETTA
State	:	GA
Zip	:	30060-2196
Country	:	US
Telephone Number	:	770-795-1234
Fax Number	:

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

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	12/04/2009

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