MEDICARE: JULIE HAZELWOOD

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1881723161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE HAZELWOOD

Provider Business Mailing Address
First Line	:	384 BLACKBURN HOLLOW RD
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-7055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 TROTWOOD AVE # B
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-7009
Country	:	US
Telephone Number	:	931-560-3050
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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