MEDICARE: HILARY WOODMAN 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	CSW00300	GA

General Provider Information

NPI Number	:	1720571086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILARY WOODMAN LCSW

Provider Business Mailing Address
First Line	:	6115 ABBOTTS BRIDGE RD APT 218
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-5753
Country	:	US
Telephone Number	:	770-363-1576
Fax Number	:	770-995-1959

Provider Business Practice Location Address
First Line	:	6100 LAKE FORREST DR STE 450
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3837
Country	:	US
Telephone Number	:	770-363-1576
Fax Number	:	770-995-1959

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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