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General NPI Number Information
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NPI Number | 1043265259
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Entity Type | Individual
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Provider Name | FRED A TEGA MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 02/09/2019
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Provider Practice Location Address
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Address Line | 15 BAYNARD PARK
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City | NEWNAN
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State | GA
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Zip | 30265-6413
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Country | US
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Telephone | 770-251-5253
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Fax | 770-251-5254
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Provider Business Mailing Address
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Address Line | 15A BAYNARD PARK
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-251-5253
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Fax | 770-251-5254
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 056493
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License Number State | GA
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