Provider Demographics
NPI:1184176224
Name:NORMAN MESA, NOEL (BS)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:NORMAN MESA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4242
Mailing Address - Country:US
Mailing Address - Phone:786-356-8305
Mailing Address - Fax:
Practice Address - Street 1:4189 WHITE RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4242
Practice Address - Country:US
Practice Address - Phone:786-356-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician