MEDICARE: JULIE DECKER

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	363LF0000X	Family Nurse Practitioner	RN138117	GA

General Provider Information

NPI Number	:	1215263637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE DECKER

Provider Business Mailing Address
First Line	:	161 WASHINGTON ST FL 14
Second Line	:	EIGHT TOWER BRIDGE, STE 1400
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2083
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	649 SHALLOWFORD RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-4146
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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