Provider Demographics
NPI:1770458739
Name:CRIDDELL, TENNEKA (LAC)
Entity type:Individual
Prefix:
First Name:TENNEKA
Middle Name:
Last Name:CRIDDELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TENNEKA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2684 CHESTNUT WALK DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST STE B5
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1958
Practice Address - Country:US
Practice Address - Phone:770-696-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist