MEDICARE: ISABELLA MIDDLETON L.AC

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	171100000X	Acupuncturist	97	GA

General Provider Information

NPI Number	:	1851410484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA MIDDLETON L.AC

Provider Business Mailing Address
First Line	:	812 CREEK VIEW LN
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4997
Country	:	US
Telephone Number	:	770-846-7600
Fax Number	:	770-518-1555

Provider Business Practice Location Address
First Line	:	4343 SHALLOWFORD RD
Second Line	:	SUITE B7A
City	:	MARIETTA
State	:	GA
Zip	:	30062-5023
Country	:	US
Telephone Number	:	770-846-7600
Fax Number	:	770-518-1555

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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