Provider Demographics
NPI:1801490669
Name:ADAMS, TERESA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 PACES FERRY AVE # C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6444
Mailing Address - Country:US
Mailing Address - Phone:770-433-2722
Mailing Address - Fax:770-433-2723
Practice Address - Street 1:2455 PACES FERRY AVE # C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6444
Practice Address - Country:US
Practice Address - Phone:770-433-2722
Practice Address - Fax:770-433-2723
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0150001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA015000OtherGA BOARD OF PHARMACY