Provider Demographics
NPI:1780185330
Name:TELFAIR, NATASHA CHARLETTE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:CHARLETTE
Last Name:TELFAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:C
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:130 ARBOR COVE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6443
Mailing Address - Country:US
Mailing Address - Phone:727-492-5154
Mailing Address - Fax:
Practice Address - Street 1:130 ARBOR COVE WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6443
Practice Address - Country:US
Practice Address - Phone:727-492-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL0211792224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060577752OtherDRIVERS LICENSE