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NPI Code Detail

MEDICARE: MR. RENE J ELY LMFT

MEDICARE: MR. RENE J ELY LMFT
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
1106H00000XMarriage & Family TherapistMFT000908GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093854853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RENE J ELY LMFT
Provider Business Mailing Address
First Line : PO BOX 1218
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-1218
Country : US
Telephone Number : 678-520-7476
Fax Number : 770-978-7676
Provider Business Practice Location Address
First Line : 1790 CENTURY BLVD NE STE A
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3322
Country : US
Telephone Number : 404-671-9226
Fax Number : 770-978-7676
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 01/17/2024

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