Active NPI
Teresita Villegas, CCC-A
- Audiologist
- Douglasville, GA
National Provider Identifier
1235250374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- AUD003145
- Practice address
- 3776 Highway 5
Douglasville, GA 30135-3368 - Phone
- (770) 714-8644
- Fax
- (678) 505-8012
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | AUD003145 | GA | Primary |
Addresses
Primary practice location
3776 Highway 5
Douglasville, GA 30135-3368
Mailing address
PO Box 5455
Douglasville, GA 30154
Phone (770) 714-8644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000804757A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090501000108 | GA | Practitioner - Qualified Audiologist | 1759439771 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456790400000",
"number": "1235250374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5455",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "30154",
"telephone_number": "770-714-8644",
"fax_number": "678-505-8012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3776 HIGHWAY 5",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301353368",
"telephone_number": "770-714-8644",
"fax_number": "678-505-8012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLEGAS",
"first_name": "TERESITA",
"name_prefix": "Mrs.",
"credential": "CCC-A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2016-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "GA",
"license": "AUD003145",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000804757A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Douglasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.