MEDICARE: ATIYA CHARLES 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	CSW005598	GA

General Provider Information

NPI Number	:	1215393939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATIYA CHARLES LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1860
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30081-1860
Country	:	US
Telephone Number	:	678-523-0970
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 CUMBERLAND CLUB DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4921
Country	:	US
Telephone Number	:	678-523-0970
Fax Number	:

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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Directions to “ ATIYA CHARLES LCSW” Practice Location

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