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NPI Code Detail

MEDICARE: MS. MARLA MICHELE OSBORNE BS IN SOCIAL WORK

MEDICARE: MS. MARLA MICHELE OSBORNE BS IN SOCIAL WORK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1053560748
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARLA MICHELE OSBORNE BS IN SOCIAL WORK
Provider Business Mailing Address
First Line : 122 GORDON COMMERCIAL DR STE A
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-5754
Country : US
Telephone Number : 706-845-4035
Fax Number : 706-845-4222
Provider Business Practice Location Address
First Line : 122 GORDON COMMERCIAL DR STE A
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-5754
Country : US
Telephone Number : 706-845-4035
Fax Number : 706-845-4222
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2008
Last Update Date : 09/17/2008

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