Provider Demographics
NPI:1245351659
Name:TEEL, GREGORY T (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:TEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2012
Mailing Address - Country:US
Mailing Address - Phone:706-657-7575
Mailing Address - Fax:706-657-4430
Practice Address - Street 1:507 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2709
Practice Address - Country:US
Practice Address - Phone:910-576-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30773207Q00000X
GA039961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956AMedicaid
GA000211956CMedicaid
NCC86887Medicare UPIN
GA000211956CMedicaid
111907Medicare Oscar/Certification