Provider Demographics
NPI:1508588955
Name:TEPTSOV, DANILA SERGEYEVICH (PA-C)
Entity Type:Individual
Prefix:
First Name:DANILA
Middle Name:SERGEYEVICH
Last Name:TEPTSOV
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2705 MALL OF GEORGIA BLVD APT 618
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8724
Mailing Address - Country:US
Mailing Address - Phone:404-455-0303
Mailing Address - Fax:
Practice Address - Street 1:95 COLLIER RD NW STE 2065
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1705
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2023-01-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant