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NPI Code Detail

MEDICARE: DR. TAKELE TESHI CHALA M.D

MEDICARE: DR. TAKELE TESHI CHALA M.D
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
1207R00000XInternal Medicine Physician073992GA
2207R00000XInternal Medicine Physician57-022038OH
3208M00000XHospitalist Physician073992GA

General Provider Information

NPI Number : 1578817383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAKELE TESHI CHALA M.D
Provider Business Mailing Address
First Line : 2518 JIMMY LEE SMITH PKWY
Second Line :
City : HIRAM
State : GA
Zip : 30141-2068
Country : US
Telephone Number : 770-732-4022
Fax Number :
Provider Business Practice Location Address
First Line : 2518 JIMMY LEE SMITH PKWY
Second Line :
City : HIRAM
State : GA
Zip : 30141-2068
Country : US
Telephone Number : 770-732-4022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2012
Last Update Date : 09/30/2019

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