Healthcare Provider Details

I. General information

NPI: 1629340047
Provider Name (Legal Business Name): GEORGIA ABNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 MANDAN RD
LITTLE ROCK AR
72210-3046
US

IV. Provider business mailing address

6007 MANDAN RD
LITTLE ROCK AR
72210-3046
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-6769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOTR 350
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: