Basic Information
| Provider Information | |||||||||
| NPI: | 1154554392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEHAN | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | BOSTON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 TECHNOLOGY PKWY NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7622351038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | ADAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301032467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4706015750 | ||||||||
| FaxNumber: | 7708773655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 74113 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.