Provider Demographics
NPI:1235519240
Name:BETUZZI-TEAS, MOYRA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:MOYRA
Middle Name:RENEE
Last Name:BETUZZI-TEAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 GREAT OAKS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8229
Mailing Address - Country:US
Mailing Address - Phone:678-635-3677
Mailing Address - Fax:
Practice Address - Street 1:517 GREAT OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8229
Practice Address - Country:US
Practice Address - Phone:678-635-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-50140207V00000X
FLME71212207V00000X
TN0000071080207V00000X
GA83736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1235519240Medicaid