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General NPI Number Information
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NPI Number | 1972743623
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Entity Type | Individual
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Provider Name | KIM SANDY TEAGUE RN, MS, CNS
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Gender | Female
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 985 RIDGE TARN
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City | ATLANTA
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State | GA
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Zip | 30350-3426
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Country | US
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Telephone | 770-399-9365
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Fax | 770-399-1871
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Provider Business Mailing Address
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Address Line | 985 RIDGE TARN
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City | ATLANTA
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State | GA
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Zip | 30350
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Country | US
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Telephone | 404-616-3454
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Fax | 404-616-4737
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN105719
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License Number State | GA
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