Active NPI
Vandelia Teal-Surratt, NP
- Adult Health Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1083980700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 17777
- Practice address
- 5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834 - Phone
- (404) 645-7563
- Fax
- (770) 874-6884
- NPI assigned
- Mar 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 17777 | SC | Primary |
Addresses
Primary practice location
5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834
Mailing address
1469 Hillian Edwards Rd
Cheraw, SC 29520-5652
Phone (843) 910-7587
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17777 | SC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palmetto Family Medicine of Chesterfield County, LLC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HJDHAD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Cheraw, SC
- NPI 1932291242
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432252800000",
"number": "1083980700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1469 HILLIAN EDWARDS RD",
"city": "CHERAW",
"state": "SC",
"postal_code": "295205652",
"telephone_number": "843-910-7587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5665 NEW NORTHSIDE DR STE 320",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303285834",
"telephone_number": "404-645-7563",
"fax_number": "770-874-6884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEAL-SURRATT",
"first_name": "VANDELIA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-27",
"last_updated": "2015-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "SC",
"license": "17777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.