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Individual

TERESA MUSTELIER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1606
(404) 851-8000
Mailing address
204 FAIRVIEW AVE, DECATUR, GA 30030-2418
(770) 779-0015

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002319
GA
363AM0700X
Medical Physician Assistant
002319
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100001328
GA
05
100001328A
GA
05
100001328B
GA
01
10043470
AMERIGROUP
GA
01
204856
BCBS
GA
01
333580
WELLCARE
GA
Enumeration date
05/17/2006
Last updated
12/19/2008
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