MEDICARE: GOLDA WINSTON 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	163WL0100X	Lactation Consultant (Registered Nurse)	RN255218	GA

General Provider Information

NPI Number	:	1518510817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOLDA WINSTON RN

Provider Business Mailing Address
First Line	:	1769 DELAWARE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2217
Country	:	US
Telephone Number	:	770-331-4779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1769 DELAWARE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2217
Country	:	US
Telephone Number	:	770-331-4779
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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