MEDICARE: CATHERINE TESLA M.S., C.G.C.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1255320172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE TESLA M.S., C.G.C.

Provider Business Mailing Address
First Line	:	8446 LAKE DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-6562
Country	:	US
Telephone Number	:	770-760-1739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2165 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5307
Country	:	US
Telephone Number	:	404-778-8526
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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