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NPI Code Detail

MEDICARE: MS. TERESA GALE OLDHAM SNIDER NP

MEDICARE: MS. TERESA GALE OLDHAM SNIDER NP
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
1363L00000XNurse PractitionerRN073598GA
2363LF0000XFamily Nurse PractitionerRN073598GA

General Provider Information

NPI Number : 1508816505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERESA GALE OLDHAM SNIDER NP
Provider Business Mailing Address
First Line : 1583 FIELDGREEN TRCE
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30088-3720
Country : US
Telephone Number : 770-981-5894
Fax Number :
Provider Business Practice Location Address
First Line : 4398 ATLANTA HWY
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7314
Country : US
Telephone Number : 678-732-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 01/25/2024

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