Healthcare Provider Details

I. General information

NPI: 1689955858
Provider Name (Legal Business Name): REENA ANALA MAHABIR EDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CARPENTER DR STE 400
ATLANTA GA
30328-4933
US

IV. Provider business mailing address

2194 HEDGEROW WAY
JONESBORO GA
30236-5299
US

V. Phone/Fax

Practice location:
  • Phone: 678-460-0345
  • Fax: 678-460-0350
Mailing address:
  • Phone: 404-435-2052
  • Fax: 678-460-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC006027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: