MEDICARE: MRS. WANDA RAGAN 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	163WC1500X	Community Health Registered Nurse	RN118147	GA

General Provider Information

NPI Number	:	1558421685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA RAGAN RN

Provider Business Mailing Address
First Line	:	132 PARADISE DR
Second Line	:
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-1659
Country	:	US
Telephone Number	:	706-867-2727
Fax Number	:	706-867-2739

Provider Business Practice Location Address
First Line	:	56 SHORT ST # A
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-0543
Country	:	US
Telephone Number	:	706-867-2727
Fax Number	:	706-867-2739

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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