MEDICARE: MS. ZENOVIA L PALMER MS

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	374J00000X	Doula
2	225700000X	Massage Therapist	MT005318	GA

General Provider Information

NPI Number	:	1699090597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ZENOVIA L PALMER MS

Provider Business Mailing Address
First Line	:	3174 IMPERIAL CIR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5209
Country	:	US
Telephone Number	:	404-783-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	3174 IMPERIAL CIR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5209
Country	:	US
Telephone Number	:	404-783-1814
Fax Number	:

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

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	04/02/2010

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