MEDICARE: TALITHA C SEIBEL CLD (ALACE)

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	374J00000X	Doula

General Provider Information

NPI Number	:	1013232461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALITHA C SEIBEL CLD (ALACE)

Provider Business Mailing Address
First Line	:	971 RICE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4973
Country	:	US
Telephone Number	:	404-933-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 RICE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4973
Country	:	US
Telephone Number	:	404-933-8857
Fax Number	:

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

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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