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General NPI Number Information
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NPI Number | 1902371644
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Entity Type | Individual
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Provider Name | CLARA MICHELLE TETER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 4482 COMMERCE DR STE 201
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City | BUFORD
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State | GA
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Zip | 30518-7503
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Country | US
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Telephone | 770-302-2251
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Fax |
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Provider Business Mailing Address
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Address Line | 2834 OVERLAKE RUN
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-5027
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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 |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN214499
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License Number State | GA
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