Provider Demographics
NPI:1144354010
Name:TRIPPE, TERESA JOYCE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JOYCE
Last Name:TRIPPE
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 1:145 NORTHCREST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-743-4632
Mailing Address - Fax:478-330-5064
Practice Address - Street 1:145 NORTHCREST BOULEVARD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-743-4632
Practice Address - Fax:478-330-5064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1200047OtherUNITED HEALTH CARE
GA617897OtherBLUE CROSS BLUE SHIELD
GA12001OtherCIGNA
GA345626OtherWELLCARE
GATRI001OtherSECURE HEALTH
GA000224518AMedicaid
GA00224518AMedicaid
GA4412624OtherAETNA
GA582347423OtherCOVENTRY HEALTH CARE