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General NPI Number Information
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NPI Number | 1699254458
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Entity Type | Individual
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Provider Name | MARY ELIZABETH WINCHESTER
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Gender | Female
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Dates
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Enumeration Date | 08/12/2018
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Last Update Date | 08/12/2018
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Provider Practice Location Address
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Address Line | 1017 FAYETTEVILLE RD SE # B
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City | ATLANTA
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State | GA
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Zip | 30316-2932
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Country | US
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Telephone | 347-881-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 READ AVE APT 1D
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City | CHATTANOOGA
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State | TN
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Zip | 37408-1800
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Country | US
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Telephone | 347-881-5060
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW008472
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License Number State | GA
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