Provider Demographics
NPI:1639568165
Name:STRICKLAND, MYHONEY ALTROVISE
Entity Type:Individual
Prefix:
First Name:MYHONEY
Middle Name:ALTROVISE
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CREEL PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7129
Mailing Address - Country:US
Mailing Address - Phone:678-379-9475
Mailing Address - Fax:
Practice Address - Street 1:1535 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1260
Practice Address - Country:US
Practice Address - Phone:678-379-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOSA050086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA830511113OtherITIN