MEDICARE: ALAN M HARBEN MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	029664	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639121718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN M HARBEN MD PHD

Provider Business Mailing Address
First Line	:	PO BOX 724928
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31139-9028
Country	:	US
Telephone Number	:	678-838-1585
Fax Number	:	678-838-1587

Provider Business Practice Location Address
First Line	:	11775 POINTE PL
Second Line	:	SUITE 103
City	:	ROSWELL
State	:	GA
Zip	:	30076-4636
Country	:	US
Telephone Number	:	770-619-0010
Fax Number	:	770-664-6511

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	TRISHA MOORE
Credential	:
Telephone Number	:	770-619-0010

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/24/2007

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