Healthcare Provider Details

I. General information

NPI: 1275579112
Provider Name (Legal Business Name): CHARLES REX TEESLINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 HENRY ST
AUGUSTA GA
30904-4656
US

IV. Provider business mailing address

2634 HENRY ST
AUGUSTA GA
30904-4656
US

V. Phone/Fax

Practice location:
  • Phone: 706-373-5771
  • Fax: 706-733-4836
Mailing address:
  • Phone: 706-373-5771
  • Fax: 706-733-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number013310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: