Provider Demographics
NPI:1568187367
Name:BREWER, TERESA FAYE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:FAYE
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 JESSE JEWELL PKWY SE STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3857
Mailing Address - Country:US
Mailing Address - Phone:770-219-7574
Mailing Address - Fax:770-219-7575
Practice Address - Street 1:825 JESSE JEWELL PKWY SE STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3857
Practice Address - Country:US
Practice Address - Phone:770-219-7574
Practice Address - Fax:770-219-7575
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000113163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant