Healthcare Provider Details

I. General information

NPI: 1568807741
Provider Name (Legal Business Name): TEQUILLA L PRYOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEQUILLA L HUNTER MD

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

1415 HIGHWAY 85 N STE 310-206
FAYETTEVILLE GA
30214-7738
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone: 404-368-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number80923
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101260570
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: