Provider Demographics
NPI:1457866444
Name:PHADAEL, LOVEL (RCP)
Entity Type:Individual
Prefix:
First Name:LOVEL
Middle Name:
Last Name:PHADAEL
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6791
Mailing Address - Country:US
Mailing Address - Phone:404-452-9872
Mailing Address - Fax:
Practice Address - Street 1:1109 GREEN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3609
Practice Address - Country:US
Practice Address - Phone:770-998-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6569227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified