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NPI Code Detail

MEDICARE: MRS. BETH S BOTNICK NP

MEDICARE: MRS. BETH S BOTNICK NP
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
1363LF0000XFamily Nurse PractitionerRN118785GA

General Provider Information

NPI Number : 1780676031
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETH S BOTNICK NP
Provider Business Mailing Address
First Line : 1430 STEPHENS DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3716
Country : US
Telephone Number : 404-403-3326
Fax Number :
Provider Business Practice Location Address
First Line : 1430 STEPHENS DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3716
Country : US
Telephone Number : 404-403-3326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 12/11/2011

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Directions to “ MRS. BETH S BOTNICK NP” Practice Location

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