Tracey Lorena Tello, CSFA, ST

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

146587 Issued in GA

Practice address

931 Monroe Drive NE
Suite 102 #641
Atlanta, GA 30308-7132

Phone

(404) 312-1633

NPI assigned

Dec 4, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1417388232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 MONROE DR NE",
            "address_2": "SUITE 102 #641",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303081793",
            "telephone_number": "404-312-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 MONROE DRIVE NE",
            "address_2": "SUITE 102 #641",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303087132",
            "telephone_number": "404-312-1633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELLO",
        "first_name": "TRACEY",
        "middle_name": "LORENA",
        "name_prefix": "Miss",
        "credential": "CSFA, ST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-04",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "146587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Keith Teliho, MD
• Rosetta Tella, PMHNP
• Juan Carlos Tellez, MD
• Alexandra Tello, AA
• Luna Tello
• Sinetsehay C Temesgen, MD
• Temple Healthcare, Inc.
• Tasha J Temple
• Erika Lynn Templeton, MD
• Ethan Templeton

• Surgical Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.