Provider Demographics
NPI:1881847754
Name:BART- TEEL, CELLANDIA G (NP)
Entity Type:Individual
Prefix:
First Name:CELLANDIA
Middle Name:G
Last Name:BART- TEEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CELLANDIA
Other - Middle Name:G
Other - Last Name:BART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1150 HAMMOND DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8617
Mailing Address - Country:US
Mailing Address - Phone:404-234-2348
Mailing Address - Fax:404-255-6532
Practice Address - Street 1:1150 HAMMOND DR STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-8617
Practice Address - Country:US
Practice Address - Phone:404-233-4275
Practice Address - Fax:404-255-6532
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335436-1363LF0000X
NY335436364SA2200X
GARN306006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03116832Medicaid