Provider Demographics
NPI:1689050254
Name:HONICAN, ALICE (LAC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HONICAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2367
Mailing Address - Country:US
Mailing Address - Phone:770-642-4646
Mailing Address - Fax:770-642-4771
Practice Address - Street 1:1745 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2367
Practice Address - Country:US
Practice Address - Phone:770-642-4646
Practice Address - Fax:770-642-4771
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist