MEDICARE: FIRST HAND EXPERIENCE

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	261Q00000X	Clinic/Center	MT000031	GA

General Provider Information

NPI Number	:	1952536344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST HAND EXPERIENCE

Provider Business Mailing Address
First Line	:	1874 PIEDMONT RD NE
Second Line	:	480D
City	:	ATLANTA
State	:	GA
Zip	:	30324-4869
Country	:	US
Telephone Number	:	404-226-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1874 PIEDMONT RD NE
Second Line	:	480D
City	:	ATLANTA
State	:	GA
Zip	:	30324-4869
Country	:	US
Telephone Number	:	404-226-3590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAY BLOUNT
Credential	:	LNMT
Telephone Number	:	404-226-3590

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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Directions to “FIRST HAND EXPERIENCE ” Practice Location

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