Basic Information
Provider Information
NPI: 1558671396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARBER
FirstName: ANGELYN
MiddleName: ISBELL
NamePrefix: MS.
NameSuffix:  
Credential: M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5455 MERIDIAN MARKS RD NE
Address2: SUITE 130
City: ATLANTA
State: GA
PostalCode: 303421654
CountryCode: US
TelephoneNumber: 4045911884
FaxNumber: 4042521901
Practice Location
Address1: 5455 MERIDIAN MARKS RD NE
Address2: SUITE 130
City: ATLANTA
State: GA
PostalCode: 303421654
CountryCode: US
TelephoneNumber: 4045911884
FaxNumber: 4042521901
Other Information
ProviderEnumerationDate: 10/14/2010
LastUpdateDate: 10/14/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X1403GAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


Home