MEDICARE: TEA HOUSE ESTHETICS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM2500X	Medical Specialty Clinic/Center
2	207N00000X	Dermatology Physician
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1841153194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEA HOUSE ESTHETICS LLC

Provider Business Mailing Address
First Line	:	1042 NORTHSIDE DRIVE NE
Second Line	:	M210
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1042 NORTHSIDE DRIVE NE
Second Line	:	M210
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:	470-538-7129
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. TORI SIMS
Credential	:
Telephone Number	:	470-538-7129

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “TEA HOUSE ESTHETICS LLC ” Practice Location

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