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General NPI Number Information
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NPI Number | 1568868172
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Entity Type | Organization
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Legal Business Name | BETUZZI-TEAS, LLC
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 11/08/2014
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Provider Practice Location Address
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Address Line | 3207 JEFFERSON SQUARE CT
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City | DECATUR
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State | GA
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Zip | 30030-1730
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Country | US
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Telephone | 515-450-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 3207 JEFFERSON SQUARE CT
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City | DECATUR
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State | GA
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Zip | 30030-1730
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Country | US
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Telephone | 515-450-3360
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | MOYRA BETUZZI-TEAS
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Credential | M.D., C.S.A
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Telephone | 515-450-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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