Provider Demographics
NPI:1386340669
Name:TEAL MEDICAL GROUP
Entity type:Organization
Organization Name:TEAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-985-7547
Mailing Address - Street 1:2045 PEACHTREE RD NE STE 412
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1408
Mailing Address - Country:US
Mailing Address - Phone:404-383-0945
Mailing Address - Fax:888-571-6147
Practice Address - Street 1:2045 PEACHTREE RD NE STE 412
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1408
Practice Address - Country:US
Practice Address - Phone:404-383-0945
Practice Address - Fax:888-571-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty