Healthcare Provider Details

I. General information

NPI: 1821181330
Provider Name (Legal Business Name): THELETHIA ANN TEASLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA TEASLEY

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NORTH BLVD
TOCCOA GA
30577
US

IV. Provider business mailing address

147 ABBEY LANE
TOCCOA GA
30577
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4507
  • Fax: 706-282-4511
Mailing address:
  • Phone: 706-886-9107
  • Fax: 706-282-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number164W00000X
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: