Provider Demographics
NPI:1003890211
Name:TEFFAULT, APRIL L (CNM)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:L
Last Name:TEFFAULT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKESHORE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3876
Mailing Address - Country:US
Mailing Address - Phone:912-673-1771
Mailing Address - Fax:912-673-1811
Practice Address - Street 1:202 LAKESHORE DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3876
Practice Address - Country:US
Practice Address - Phone:912-673-1771
Practice Address - Fax:912-673-1811
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA128774176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000907607Medicaid
GA000907607Medicaid