MEDICARE: MRS. SARA K TETTELBACH

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	374J00000X	Doula

General Provider Information

NPI Number	:	1225546856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA K TETTELBACH

Provider Business Mailing Address
First Line	:	5777 LOST GROVE DR NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-6161
Country	:	US
Telephone Number	:	770-905-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 LOST GROVE DR NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-6161
Country	:	US
Telephone Number	:	770-905-9822
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	12/26/2025

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