MEDICARE: NAOMI ELAINE BUSLER LMSW

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	104100000X	Social Worker	MSW007435	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MSW007435	OTHER	GA	LMSW LICENCE NUMBER

General Provider Information

NPI Number	:	1972010734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI ELAINE BUSLER LMSW

Provider Business Mailing Address
First Line	:	1950 SPECTRUM CIR SE STE 145
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8470
Country	:	US
Telephone Number	:	678-921-2706
Fax Number	:	678-388-8649

Provider Business Practice Location Address
First Line	:	1950 SPECTRUM CIR SE STE 145
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8470
Country	:	US
Telephone Number	:	678-921-2706
Fax Number	:	678-388-8649

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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