MEDICARE: MRS. MERRIOM LASAN HASHIM RN

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	163W00000X	Registered Nurse	RN 174749	GA
2	163W00000X	Registered Nurse	R 105501	SC
3	163W00000X	Registered Nurse	0001182357	VA
4	163WC1500X	Community Health Registered Nurse	RN174749	GA

General Provider Information

NPI Number	:	1184824781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERRIOM LASAN HASHIM RN

Provider Business Mailing Address
First Line	:	3335 THAMES PL
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7167
Country	:	US
Telephone Number	:	706-560-1179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 THAMES PL
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7167
Country	:	US
Telephone Number	:	706-560-1179
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/26/2010

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