Healthcare Provider Details

I. General information

NPI: 1245351659
Provider Name (Legal Business Name): GREGORY T. TEEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MAIN ST
TROY NC
27371-2709
US

IV. Provider business mailing address

13570 N MAIN ST
TRENTON GA
30752-2012
US

V. Phone/Fax

Practice location:
  • Phone: 910-576-0042
  • Fax:
Mailing address:
  • Phone: 706-657-7575
  • Fax: 706-657-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30773
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039961
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: