Healthcare Provider Details

I. General information

NPI: 1467068890
Provider Name (Legal Business Name): TEWANN TEPPER LPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 THE EXCHANGE SE
ATLANTA GA
30339-7400
US

IV. Provider business mailing address

5701 RUTLAND CIR
POWDER SPRINGS GA
30127-4776
US

V. Phone/Fax

Practice location:
  • Phone: 770-401-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TISA MACKLIN
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 404-827-8038