Provider Demographics
NPI:1356890107
Name:MURRAH, ANGELA
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:MURRAH
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 1:8712 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4905
Mailing Address - Country:US
Mailing Address - Phone:770-478-3417
Mailing Address - Fax:770-478-3419
Practice Address - Street 1:8712 TARA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4905
Practice Address - Country:US
Practice Address - Phone:770-478-3417
Practice Address - Fax:770-478-3419
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 103K00000X
GA101YP2500X, 390200000X
GA2004103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program