| Doctor Name: | TERESA CLEAVES |
| NPI Number: | 1013154483 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSA |
| License Number: | 03012108 |
| Business Practice Address: | 804 River Mist Dr Jonesboro, GA - 302385748 |
| Business Phone Number: | 7709854257 |
| Business Fax Number: | 7709854258 |
| Mailing Address: | 804 River Mist Dr, JONESBORO |
| State: | GA |
| Postal Code: | 302385748 |
| Phone Number: | 7709854257 |
| Fax Number: | 7709854258 |
| NPI Enumeration Date: | 01/07/2009 |
| NPI Last Update Date: | 01/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 03012108 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |