MEDICARE: CANDICE TATE MD

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	2084P0800X	Psychiatry Physician	036109593	IL
2	2084P0800X	Psychiatry Physician	059967	GA

General Provider Information

NPI Number	:	1063474013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE TATE MD

Provider Business Mailing Address
First Line	:	400 GALLERIA PKWY SE
Second Line	:	SUITE 1500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5980
Country	:	US
Telephone Number	:	770-644-9212
Fax Number	:	770-644-9213

Provider Business Practice Location Address
First Line	:	400 GALLERIA PKWY SE
Second Line	:	SUITE 1500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5980
Country	:	US
Telephone Number	:	770-644-9212
Fax Number	:	770-644-9213

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	09/29/2010

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Directions to “ CANDICE TATE MD” Practice Location

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