Provider Demographics
NPI:1972743623
Name:TEAGUE, KIM SANDY (RN, MS, CNS)
Entity Type:Individual
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First Name:KIM
Middle Name:SANDY
Last Name:TEAGUE
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Gender:F
Credentials:RN, MS, CNS
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Mailing Address - Street 1:985 RIDGE TARN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350
Mailing Address - Country:US
Mailing Address - Phone:404-616-3454
Mailing Address - Fax:404-616-4737
Practice Address - Street 1:985 RIDGE TARN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3426
Practice Address - Country:US
Practice Address - Phone:770-399-9365
Practice Address - Fax:770-399-1871
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
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Provider Licenses
StateLicense IDTaxonomies
GARN105719364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health