Provider Demographics
NPI:1639121718
Name:ALAN M HARBEN MD PHD
Entity Type:Organization
Organization Name:ALAN M HARBEN MD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0010
Mailing Address - Street 1:PO BOX 724928
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-9028
Mailing Address - Country:US
Mailing Address - Phone:678-838-1585
Mailing Address - Fax:678-838-1587
Practice Address - Street 1:11775 POINTE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:770-619-0010
Practice Address - Fax:770-664-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0296642081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00349137IMedicaid
GA00349137CMedicaid
GA00349137CMedicaid