Healthcare Provider Details

I. General information

NPI: 1972743623
Provider Name (Legal Business Name): KIM SANDY TEAGUE RN, MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 RIDGE TARN
ATLANTA GA
30350-3426
US

IV. Provider business mailing address

985 RIDGE TARN
ATLANTA GA
30350
US

V. Phone/Fax

Practice location:
  • Phone: 770-399-9365
  • Fax: 770-399-1871
Mailing address:
  • Phone: 404-616-3454
  • Fax: 404-616-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN105719
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: