MEDICARE: NAN W DECOLAINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	225C00000X	Rehabilitation Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245824424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAN W DECOLAINES

Provider Business Mailing Address
First Line	:	PO BOX 143
Second Line	:
City	:	HIGH SHOALS
State	:	GA
Zip	:	30645-0143
Country	:	US
Telephone Number	:	706-202-6549
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 PLANTATION RD
Second Line	:
City	:	N HIGH SHOALS
State	:	GA
Zip	:	30621-1511
Country	:	US
Telephone Number	:	706-202-6549
Fax Number	:

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

Provider Enumeration Date	:	02/27/2021
Last Update Date	:	02/27/2021

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Directions to “ NAN W DECOLAINES ” Practice Location

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