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General NPI Number Information
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NPI Number | 1487399416
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Entity Type | Individual
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Provider Name | MARGARET S. LICAVOLI
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 123 WEAVER RD STE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3155
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Country | US
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Telephone | 170-643-9648
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Fax |
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Provider Business Mailing Address
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Address Line | 351 E HIGHLAND ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN168368
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License Number State | GA
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