MEDICARE: MRS. KARLA RILEY CLD

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	374J00000X	Doula		GA

General Provider Information

NPI Number	:	1336564715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARLA RILEY CLD

Provider Business Mailing Address
First Line	:	1645 LAKE HEIGHTS CIR
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 LAKE HEIGHTS CIR
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3239
Country	:	US
Telephone Number	:	404-514-6593
Fax Number	:

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

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	02/21/2014

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