Provider Demographics
NPI:1235514910
Name:PRICE, TERESA (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-3588
Mailing Address - Country:US
Mailing Address - Phone:256-236-6060
Mailing Address - Fax:256-236-6172
Practice Address - Street 1:1005 W 18TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-3588
Practice Address - Country:US
Practice Address - Phone:256-236-6060
Practice Address - Fax:256-236-6172
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant