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NPI Code Detail

MEDICARE: FELICIA ANASTASIA SAMPLE

MEDICARE: FELICIA ANASTASIA SAMPLE
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
1163W00000XRegistered NurseRN164418GA

General Provider Information

NPI Number : 1578161873
Entity Type Code : Individual
Provider Name (Legal Business Name) : FELICIA ANASTASIA SAMPLE
Provider Business Mailing Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-485-9186
Fax Number :
Provider Business Practice Location Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-485-9186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/09/2020

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Directions to “ FELICIA ANASTASIA SAMPLE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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