MEDICARE: MS. MEREDITH LISA ALBERT LMCW

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	1041C0700X	Clinical Social Worker	MSW003645	GA
2	1041C0700X	Clinical Social Worker	CSW003929	GA

General Provider Information

NPI Number	:	1548304991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEREDITH LISA ALBERT LMCW

Provider Business Mailing Address
First Line	:	3164 KENSINGTON RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1456
Country	:	US
Telephone Number	:	404-844-1691
Fax Number	:	404-844-1691

Provider Business Practice Location Address
First Line	:	3164 KENSINGTON RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1456
Country	:	US
Telephone Number	:	404-844-1691
Fax Number	:	404-844-1691

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/15/2010

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