Provider Demographics
NPI:1427093731
Name:TEAL, BROOKE B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:B
Last Name:TEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:1020 J L WHITE DR STE 160
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4910
Practice Address - Country:US
Practice Address - Phone:706-692-0603
Practice Address - Fax:678-581-7109
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2019-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004814363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427093731OtherNPI NUMBER
GA683984257BMedicaid
GA683984257CMedicaid
GA683984257AMedicaid
GA683984257CMedicaid