MEDICARE: MS. POLLY PAGE HART 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	CSW000488	GA

General Provider Information

NPI Number	:	1134241896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. POLLY PAGE HART LCSW

Provider Business Mailing Address
First Line	:	7000 PEACHTREE DUNWOODY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-1655
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

Provider Business Practice Location Address
First Line	:	7000 PEACHTREE DUNWOODY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-1655
Country	:	US
Telephone Number	:	770-393-1880
Fax Number	:	770-393-1885

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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