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General NPI Number Information
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NPI Number | 1841153194
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Entity Type | Organization
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Legal Business Name | TEA HOUSE ESTHETICS LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1042 NORTHSIDE DRIVE NE M210
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City | ATLANTA
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State | GA
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Zip | 30324
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Country | US
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Telephone | 470-538-7129
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 NORTHSIDE DRIVE NE M210
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City | ATLANTA
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State | GA
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Zip | 30324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. TORI SIMS
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Credential |
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Telephone | 470-538-7129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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