Basic Information
| Provider Information | |||||||||
| NPI: | 1568449478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5775 GLENRIDGE DR NE | ||||||||
| Address2: | BUILDING B, SUITE 145 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303285380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
| FaxNumber: | 7703999449 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 BOULEVARD NE | ||||||||
| Address2: | SUITE 432 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303121200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
| FaxNumber: | 7703999449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 029003 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 00399341C | 05 | GA | MEDICAID |