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NPI Code Detail

MEDICARE: AMANDA TEER PSYD

MEDICARE: AMANDA TEER PSYD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1336837111
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA TEER PSYD
Provider Business Mailing Address
First Line : 675 RIVER OAK LOOP
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5657
Country : US
Telephone Number : 770-864-2510
Fax Number :
Provider Business Practice Location Address
First Line : 32 LENOX POINTE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-5699
Country : US
Telephone Number : 404-590-4382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2023
Last Update Date : 04/28/2023

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