MEDICARE: MS. LETITIA ANTIONETTE MCDANIEL MAA

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		GA

General Provider Information

NPI Number	:	1790319366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETITIA ANTIONETTE MCDANIEL MAA

Provider Business Mailing Address
First Line	:	10 GLENLAKE PKWY STE 130
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3495
Country	:	US
Telephone Number	:	678-222-3419
Fax Number	:	678-222-3401

Provider Business Practice Location Address
First Line	:	10 GLENLAKE PKWY STE 130
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3495
Country	:	US
Telephone Number	:	770-572-6757
Fax Number	:	678-222-3401

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

Provider Enumeration Date	:	02/23/2020
Last Update Date	:	01/25/2023

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