Provider Demographics
NPI:1588774467
Name:LAPAQUETTE, TERU KAY (MD)
Entity type:Individual
Prefix:DR
First Name:TERU
Middle Name:KAY
Last Name:LAPAQUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:GA
Mailing Address - Zip Code:30139-3011
Mailing Address - Country:US
Mailing Address - Phone:770-720-1326
Mailing Address - Fax:770-720-2799
Practice Address - Street 1:200 OAKSIDE LN
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6416
Practice Address - Country:US
Practice Address - Phone:770-720-1326
Practice Address - Fax:770-720-2799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039148207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDSPHMedicare ID - Type Unspecified
GAF87931Medicare UPIN