MEDICARE: MR. JOSEPH MELTON BIRD LICSW

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	0890001045	VT

General Provider Information

NPI Number	:	1083613665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MELTON BIRD LICSW

Provider Business Mailing Address
First Line	:	300 EAST HOSPITAL ROAD
Second Line	:	ROOM 13A-10
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-6377
Fax Number	:	706-787-1458

Provider Business Practice Location Address
First Line	:	300 EAST HOSPITAL ROAD
Second Line	:	ROOM 13A-10
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-6377
Fax Number	:	706-787-1458

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/29/2013

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