MEDICARE: ERICA FARMER

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1730791641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA FARMER

Provider Business Mailing Address
First Line	:	57 E WRIGHT ST
Second Line	:
City	:	WINDER
State	:	GA
Zip	:	30680-2138
Country	:	US
Telephone Number	:	470-535-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 WHITES BOTTOM RD
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-2814
Country	:	US
Telephone Number	:	470-535-5907
Fax Number	:

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

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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