MEDICARE: JAMES H. BIRD LCSW JAMES BIRD

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	000113	GA

General Provider Information

NPI Number	:	1811020589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H. BIRD LCSW JAMES BIRD

Provider Business Mailing Address
First Line	:	3086 PEACHTREE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2754
Country	:	US
Telephone Number	:	404-262-1819
Fax Number	:	404-262-1819

Provider Business Practice Location Address
First Line	:	3086 PEACHTREE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2754
Country	:	US
Telephone Number	:	404-262-1819
Fax Number	:	404-262-1819

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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