=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306278056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULTONCOUNTYGOVERMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 08/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 SUNSET AVE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-612-9343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 SUNSET AVE NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30314-4059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-612-9343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | JULIET COOPER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 404-906-2094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | RN078743
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------