Provider Demographics
NPI:1689427502
Name:BUTLER-TEAL, SHELIA T
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:T
Last Name:BUTLER-TEAL
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 1:1256 ASKEW DR NE
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-1283
Mailing Address - Country:US
Mailing Address - Phone:229-575-6141
Mailing Address - Fax:
Practice Address - Street 1:1256 ASKEW DR NE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1283
Practice Address - Country:US
Practice Address - Phone:229-575-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306075163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health