Provider Demographics
NPI:1063112431
Name:TEAKAY MERIT, INC.
Entity type:Organization
Organization Name:TEAKAY MERIT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUZANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-330-2969
Mailing Address - Street 1:1852 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1106
Mailing Address - Country:US
Mailing Address - Phone:770-330-2969
Mailing Address - Fax:888-550-2426
Practice Address - Street 1:195 KING AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6736
Practice Address - Country:US
Practice Address - Phone:706-543-6261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty