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General NPI Number Information
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NPI Number | 1235519240
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Entity Type | Individual
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Provider Name | MOYRA RENEE BETUZZI-TEAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 517 GREAT OAKS DR STE 102
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City | MONROE
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State | GA
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Zip | 30655-8229
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Country | US
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Telephone | 678-635-3677
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Fax |
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Provider Business Mailing Address
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Address Line | 517 GREAT OAKS DR STE 102
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City | MONROE
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State | GA
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Zip | 30655-8229
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Country | US
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Telephone | 678-635-3677
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 04-50140
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME71212
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0000071080
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 83736
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License Number State | GA
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