Provider Demographics
NPI:1700394616
Name:GATLING, TERESA SAMIKIA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SAMIKIA
Last Name:GATLING
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 1:105 PROFESSIONAL PKWY STE 1528
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4335
Mailing Address - Country:US
Mailing Address - Phone:757-270-7774
Mailing Address - Fax:
Practice Address - Street 1:105 PROFESSIONAL PKWY STE 1528
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4335
Practice Address - Country:US
Practice Address - Phone:757-270-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health