MEDICARE: PARTNER TRAUMA CARE NETWORK

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1124450895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNER TRAUMA CARE NETWORK

Provider Business Mailing Address
First Line	:	9 DUNWOODY PARK
Second Line	:	SUITE 136
City	:	ATLANTA
State	:	GA
Zip	:	30338-7407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 DUNWOODY PARK
Second Line	:	SUITE 136
City	:	ATLANTA
State	:	GA
Zip	:	30338-7407
Country	:	US
Telephone Number	:	770-853-8333
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RICHARD BLANKENSHIP
Credential	:	LPC, NCC, CCH, CCSAS
Telephone Number	:	770-853-8333

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/05/2013

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