Provider Demographics
NPI:1669652095
Name:HARBEN, ALAN M (MD,PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:HARBEN
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 POINTE PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4655
Mailing Address - Country:US
Mailing Address - Phone:770-619-0010
Mailing Address - Fax:770-664-6511
Practice Address - Street 1:11775 POINTE PLACE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4652
Practice Address - Country:US
Practice Address - Phone:770-619-0010
Practice Address - Fax:770-664-6511
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029664208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00349137IMedicaid
GA00349137CMedicaid