Provider Demographics
NPI:1831184944
Name:HATTEN, TERESA L (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:HATTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4206
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-9809
Practice Address - Street 1:908 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4206
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-9809
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031018207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000402685BMedicaid
GA000402685BMedicaid
GA511I110787Medicare PIN
GAE16149Medicare UPIN