MEDICARE: MERRINE T. MCDONALD LCSW

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	CSW001992	GA

General Provider Information

NPI Number	:	1588867071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRINE T. MCDONALD LCSW

Provider Business Mailing Address
First Line	:	319 GLENN ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-2512
Country	:	US
Telephone Number	:	404-522-3733
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 PIEDMONT AVE NE
Second Line	:	SUITE 501
City	:	ATLANTA
State	:	GA
Zip	:	30308-1423
Country	:	US
Telephone Number	:	404-218-6598
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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