MEDICARE: JULIE HENDERSON SHEPHERD LMSW

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	101Y00000X	Counselor	MSW004128	GA

General Provider Information

NPI Number	:	1336294065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE HENDERSON SHEPHERD LMSW

Provider Business Mailing Address
First Line	:	1304A N MORNINGSIDE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3368
Country	:	US
Telephone Number	:	404-875-7678
Fax Number	:

Provider Business Practice Location Address
First Line	:	776 WINDSOR PKWY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2849
Country	:	US
Telephone Number	:	404-303-7247
Fax Number	:	404-303-7837

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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