Basic Information
| Provider Information | |||||||||
| NPI: | 1053572172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDLIN | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | CLAIR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 PROSPERITY WAY NE | ||||||||
| Address2: | TAKE CARE HEALTH @ LOWES ROME | ||||||||
| City: | ADAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067289151 | ||||||||
| FaxNumber: | 7067289153 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 PROSPERITY WAY NE | ||||||||
| Address2: | |||||||||
| City: | ADAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787210705 | ||||||||
| FaxNumber: | 6787215116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN070135 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.