MEDICARE: TEILA PROPERTY MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1144805177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEILA PROPERTY MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2038 FONTAINBLEAU DR
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-4842
Country	:	US
Telephone Number	:	770-407-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2274 SALEM RD SE STE 1061336
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-2097
Country	:	US
Telephone Number	:	770-407-9923
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TEILA TYLER
Credential	:
Telephone Number	:	770-407-9923

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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