MEDICARE: MS. FAYE LEWIS GROOVER OWNER

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	3747P1801X	Personal Care Attendant		GA

General Provider Information

NPI Number	:	1962407957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAYE LEWIS GROOVER OWNER

Provider Business Mailing Address
First Line	:	1487 ALLEN RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-5817
Country	:	US
Telephone Number	:	478-785-9779
Fax Number	:	478-785-9779

Provider Business Practice Location Address
First Line	:	1487 ALLEN RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-5817
Country	:	US
Telephone Number	:	478-785-9779
Fax Number	:	478-785-9779

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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