Provider Demographics
NPI:1346861127
Name:TEDLA, FINAN (NP)
Entity Type:Individual
Prefix:
First Name:FINAN
Middle Name:
Last Name:TEDLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11823
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-1823
Mailing Address - Country:US
Mailing Address - Phone:602-692-2082
Mailing Address - Fax:
Practice Address - Street 1:2626 PEACHTREE RD NW UNIT 1802
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-5633
Practice Address - Country:US
Practice Address - Phone:602-692-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF12180424363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty