Healthcare Provider Details

I. General information

NPI: 1487445029
Provider Name (Legal Business Name): TERESA SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD BLDG H
MARIETTA GA
30068-5518
US

IV. Provider business mailing address

273 SHELTON CIR
TEMPLE GA
30179-5495
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-0364
  • Fax:
Mailing address:
  • Phone: 770-634-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: