MEDICARE: MRS. TEDDI THORNBURG ZAYAS PA-C

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	363A00000X	Physician Assistant	003274	GA
2	363A00000X	Physician Assistant	0010-04875	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235105966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEDDI THORNBURG ZAYAS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 744786
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4786
Country	:	US
Telephone Number	:	704-834-2450
Fax Number	:	704-671-5331

Provider Business Practice Location Address
First Line	:	120 S MOUNTAIN ST
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021-3421
Country	:	US
Telephone Number	:	704-435-5227
Fax Number	:	704-435-5233

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	12/09/2021

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