Provider Demographics
NPI:1235519240
Name:BETUZZI-TEAS, MOYRA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOYRA
Middle Name:RENEE
Last Name:BETUZZI-TEAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MALL OF GEORGIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8791
Mailing Address - Country:US
Mailing Address - Phone:706-335-3555
Mailing Address - Fax:706-336-8122
Practice Address - Street 1:2527 MALL OF GEORGIA BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:706-335-3555
Practice Address - Fax:706-336-8122
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1235519240Medicaid