MEDICARE: DR. AVRIL L'MOUR WEATHERS PH.D.

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	101YM0800X	Mental Health Counselor
2	171W00000X	Contractor
3	174400000X	Specialist	27005	IL

General Provider Information

NPI Number	:	1053569681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVRIL L'MOUR WEATHERS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 56025
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30343-0025
Country	:	US
Telephone Number	:	404-567-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NORTHSIDE DR NW
Second Line	:	UPPER LEVEL
City	:	ATLANTA
State	:	GA
Zip	:	30318-7023
Country	:	US
Telephone Number	:	404-567-4272
Fax Number	:

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/08/2008

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