MEDICARE: EVE M MASCHINOT N.P.

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	363L00000X	Nurse Practitioner	R85001	GA

General Provider Information

NPI Number	:	1912060559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE M MASCHINOT N.P.

Provider Business Mailing Address
First Line	:	218 MAEDIRIS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 WHITEFOORD AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1727
Country	:	US
Telephone Number	:	404-588-0101
Fax Number	:	404-588-0226

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/17/2015

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