Provider Demographics
NPI:1003161902
Name:TEAL, NORMAN MICHAEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:MICHAEL
Last Name:TEAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 BLACKSHEAR DR
Mailing Address - Street 2:APT-C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2606
Mailing Address - Country:US
Mailing Address - Phone:404-668-6400
Mailing Address - Fax:
Practice Address - Street 1:3161 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 410
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2135
Practice Address - Country:US
Practice Address - Phone:404-352-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist