Individual
MISS TRACEY LORENA TELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA, ST
Contact information
Practice address
931 MONROE DRIVE NE, SUITE 102 #641, ATLANTA, GA 30308-7132
(404) 312-1633
Mailing address
931 MONROE DR NE, SUITE 102 #641, ATLANTA, GA 30308-1793
(404) 312-1633
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
146587
GA
Other
Enumeration date
12/04/2013
Last updated
11/28/2018
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