MEDICARE: BRIAN AUSTIN TEAL LCSW

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	1041C0700X	Clinical Social Worker		AR
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program
4	1041C0700X	Clinical Social Worker	CSW006390	GA

General Provider Information

NPI Number	:	1215285028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN AUSTIN TEAL LCSW

Provider Business Mailing Address
First Line	:	1441 WOODMONT LN NW STE 1988
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	901-563-8565
Fax Number	:	678-974-0228

Provider Business Practice Location Address
First Line	:	1441 WOODMONT LN NW
Second Line	:	STE 1988
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	901-604-7463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	07/21/2023

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