MEDICARE: SICKLE CELL FOUNDATION OF GEORGIA, INC.

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	291U00000X	Clinical Medical Laboratory	LAB000323	GA

General Provider Information

NPI Number	:	1639500648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SICKLE CELL FOUNDATION OF GEORGIA, INC.

Provider Business Mailing Address
First Line	:	2391 BENJAMIN E MAYS DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3251
Country	:	US
Telephone Number	:	404-755-2291
Fax Number	:	404-755-5377

Provider Business Practice Location Address
First Line	:	2391 BENJAMIN E MAYS DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3251
Country	:	US
Telephone Number	:	404-755-2291
Fax Number	:	404-755-5377

Authorized Official
Title or Position	:	BILLING CLERK
Name	:	EBONY GASTON
Credential	:
Telephone Number	:	404-755-2291

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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