MEDICARE: KAREN S. MINCEY

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	2083X0100X	Occupational Medicine Physician	LPN047302	GA

General Provider Information

NPI Number	:	1134388911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN S. MINCEY

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 MINIS AVE
Second Line	:	SUITE C-10
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2128
Country	:	US
Telephone Number	:	123-456-7890
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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