Provider Demographics
NPI:1487445029
Name:SKINNER, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 SHELTON CIR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-5495
Mailing Address - Country:US
Mailing Address - Phone:770-634-8904
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD BLDG H
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5518
Practice Address - Country:US
Practice Address - Phone:770-977-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant