Healthcare Provider Details

I. General information

NPI: 1790832541
Provider Name (Legal Business Name): TERESA YVONNE MCLAUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR SUITE 213
LAWRENCEVILLE GA
30045-8444
US

IV. Provider business mailing address

175 GWINNETT DR SUITE 213
LAWRENCEVILLE GA
30045-8444
US

V. Phone/Fax

Practice location:
  • Phone: 678-377-3745
  • Fax: 678-990-3997
Mailing address:
  • Phone: 678-377-3745
  • Fax: 678-990-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: