MEDICARE: MRS. ANICIA SULLIVAN BIGLOW APRN, BS

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	RN058793	GA

General Provider Information

NPI Number	:	1487867115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANICIA SULLIVAN BIGLOW APRN, BS

Provider Business Mailing Address
First Line	:	390 17TH ST NW
Second Line	:	UNIT 2020
City	:	ATLANTA
State	:	GA
Zip	:	30363-1018
Country	:	US
Telephone Number	:	404-541-9699
Fax Number	:	404-541-9698

Provider Business Practice Location Address
First Line	:	390 17TH ST NW
Second Line	:	UNIT 2020
City	:	ATLANTA
State	:	GA
Zip	:	30363-2000
Country	:	US
Telephone Number	:	404-541-9699
Fax Number	:	404-541-9698

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/27/2007

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