MEDICARE: MRS. KARLA REDMAN LCSW

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
1	1041C0700X	Clinical Social Worker	CSW002682	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073691911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARLA REDMAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2746
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30028-6509
Country	:	US
Telephone Number	:	678-447-5063
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 ATLANTA HWY STE 1301
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:	786-447-5063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/27/2021

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