MEDICARE: MS. HELEN ROSEMARY STOCKWELL MSN

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	363L00000X	Nurse Practitioner	RN113476	GA

General Provider Information

NPI Number	:	1649259599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN ROSEMARY STOCKWELL MSN

Provider Business Mailing Address
First Line	:	1835 SAVOY DR
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30341-1072
Country	:	US
Telephone Number	:	770-496-9400
Fax Number	:	770-496-9495

Provider Business Practice Location Address
First Line	:	6002 PROFESSIONAL PKWY
Second Line	:	SUITE 200
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5600
Country	:	US
Telephone Number	:	770-496-9400
Fax Number	:	770-496-9495

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	02/26/2008

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