Basic Information
| Provider Information | |||||||||
| NPI: | 1093301731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HSIEH | ||||||||
| FirstName: | EBELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NECTARINE DR | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266753174 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1858 CHESHIRE BRIDGE RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303244945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704476471 | ||||||||
| FaxNumber: | 8556948272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2020 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 024409 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.