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NPI Code Detail

MEDICARE: ROCHELLE WYCHE

MEDICARE: ROCHELLE WYCHE
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
1156F00000XTechnician/Technologist

General Provider Information

NPI Number : 1003423153
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROCHELLE WYCHE
Provider Business Mailing Address
First Line : 2100 ELLISON LAKES DR NW APT 1217
Second Line :
City : KENNESAW
State : GA
Zip : 30152-6741
Country : US
Telephone Number : 404-433-5015
Fax Number :
Provider Business Practice Location Address
First Line : 4920 ROSWELL RD STE 1
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2684
Country : US
Telephone Number : 470-258-4163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2020
Last Update Date : 09/23/2020

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Directions to “ ROCHELLE WYCHE ” Practice Location

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