MEDICARE: MRS. SHELIA HEAD 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	CSW000491	GA

General Provider Information

NPI Number	:	1760640023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELIA HEAD LCSW

Provider Business Mailing Address
First Line	:	1895 PHOENIX BLVD
Second Line	:	166
City	:	ATLANTA
State	:	GA
Zip	:	30349-5592
Country	:	US
Telephone Number	:	404-271-8443
Fax Number	:	404-344-7480

Provider Business Practice Location Address
First Line	:	1895 PHOENIX BLVD
Second Line	:	166
City	:	ATLANTA
State	:	GA
Zip	:	30349-5592
Country	:	US
Telephone Number	:	404-271-8443
Fax Number	:	404-344-7480

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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