MEDICARE: MS. ELIZABETH ANN BOSTICK RN

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	163WC1500X	Community Health Registered Nurse	144415	GA

General Provider Information

NPI Number	:	1497926448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANN BOSTICK RN

Provider Business Mailing Address
First Line	:	3699 BAKERS FERRY RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3712
Country	:	US
Telephone Number	:	404-699-4215
Fax Number	:	404-893-6761

Provider Business Practice Location Address
First Line	:	3699 BAKERS FERRY RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3712
Country	:	US
Telephone Number	:	404-699-4215
Fax Number	:	404-893-6761

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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