MEDICARE: LASHAWN RENEE MCCARTY RN, CRNA

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	367500000X	Certified Registered Nurse Anesthetist	077532	GA

General Provider Information

NPI Number	:	1396914255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWN RENEE MCCARTY RN, CRNA

Provider Business Mailing Address
First Line	:	3848 CHERRY RIDGE BLVD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-5050
Country	:	US
Telephone Number	:	404-212-0045
Fax Number	:	404-212-6980

Provider Business Practice Location Address
First Line	:	3848 CHERRY RIDGE BLVD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-5050
Country	:	US
Telephone Number	:	404-212-0045
Fax Number	:	404-212-6980

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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