MEDICARE: MRS. DENISE RENEE DRAKE RNFA

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	163WS0121X	Plastic Surgery Registered Nurse	RN108059	GA
2	163WS0121X	Plastic Surgery Registered Nurse	R200164	SC

General Provider Information

NPI Number	:	1336315597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE RENEE DRAKE RNFA

Provider Business Mailing Address
First Line	:	747 RALPH MC GILL BLVD NE UNIT 1207
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1134
Country	:	US
Telephone Number	:	843-271-7465
Fax Number	:	955-485-0217

Provider Business Practice Location Address
First Line	:	747 RALPH MCGILL BLVD NE UNIT 1207
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1134
Country	:	US
Telephone Number	:	843-271-7465
Fax Number	:	955-485-0217

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	02/17/2012

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