MEDICARE: MRS. NATALIE DIONNE HASLEM PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN214143	GA

General Provider Information

NPI Number	:	1164900551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE DIONNE HASLEM PMHNP-BC

Provider Business Mailing Address
First Line	:	6554 BRANDEMERE WAY
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-5339
Country	:	US
Telephone Number	:	770-941-5164
Fax Number	:	770-941-5164

Provider Business Practice Location Address
First Line	:	4171 MARIETTA ST STE 200
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2696
Country	:	US
Telephone Number	:	770-943-8701
Fax Number	:	770-943-8936

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/08/2022

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