Provider Demographics
NPI:1235105966
Name:ZAYAS, TEDDI THORNBURG (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TEDDI
Middle Name:THORNBURG
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TEDDI
Other - Middle Name:JANE
Other - Last Name:ZAYAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:120 S MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-3421
Practice Address - Country:US
Practice Address - Phone:704-435-5227
Practice Address - Fax:704-435-5233
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003274363A00000X
NC0010-04875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001370GMedicaid
GA202I975905Medicare PIN
NCNCJ752AMedicare PIN
GAS84505Medicare UPIN