MEDICARE: TERESA BEAVERS

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	335E00000X	Prosthetic/Orthotic Supplier		GA

General Provider Information

NPI Number	:	1609730142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA BEAVERS

Provider Business Mailing Address
First Line	:	2870 PEACHTREE RD NW # 915-1369
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2918
Country	:	US
Telephone Number	:	678-849-6927
Fax Number	:

Provider Business Practice Location Address
First Line	:	2870 PEACHTREE RD NW # 915-1369
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2918
Country	:	US
Telephone Number	:	678-849-6927
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ TERESA BEAVERS ” Practice Location

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