MEDICARE: ELLEN ALTSCHULER

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	CSW001618	GA

General Provider Information

NPI Number	:	1750753752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ALTSCHULER

Provider Business Mailing Address
First Line	:	3019 COACH LN
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5018
Country	:	US
Telephone Number	:	770-789-2470
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 WINSTON CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-2714
Country	:	US
Telephone Number	:	770-756-9543
Fax Number	:	770-703-3332

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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Directions to “ ELLEN ALTSCHULER ” Practice Location

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