Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 128774 | GA |
NPI | 1003890211 |
---|---|
Provider Name | April L Teffault |
First Address | Saint Marys, GA 31558-3876 |
Second Address | Saint Marys, GA 31558-3876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000907607 | (05) | GA |
P45894 | (02) | GA |