Active NPI
Teniqua Moffatte
- Orthotic Fitter
- Douglasville, GA
National Provider Identifier
1235722968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotic Fitter
- Practice address
- 1688 Jefferson LN
Douglasville, GA 30134-3249 - Phone
- (470) 848-2679
- NPI assigned
- Feb 13, 2021
- 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 |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | Primary |
Addresses
Primary practice location
1688 Jefferson LN
Douglasville, GA 30134-3249
Mailing address
1688 Jefferson LN
Douglasville, GA 30134-3249
Phone (470) 848-2679
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 4705926123 |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613174400000",
"number": "1235722968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1688 JEFFERSON LN",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301343249",
"telephone_number": "470-848-2679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1688 JEFFERSON LN",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301343249",
"telephone_number": "470-848-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFATTE",
"first_name": "TENIQUA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-13",
"last_updated": "2021-02-13",
"certification_date": "2021-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "4705926123",
"affiliation": "N",
"endpointDescription": "Fax",
"address_1": "1688 Jefferson Ln",
"city": "Douglasville",
"state": "GA",
"country_code": "US",
"postal_code": "301343249",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Feb 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.