Healthcare Provider Details

I. General information

NPI: 1669633657
Provider Name (Legal Business Name): DR. VALRIE M. HONABLUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD SUITE H
ATLANTA GA
30338-6520
US

IV. Provider business mailing address

PO BOX 421667
ATLANTA GA
30342-8667
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-1252
  • Fax: 770-454-1256
Mailing address:
  • Phone: 770-454-1252
  • Fax: 770-454-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number037835
License Number StateGA

VIII. Authorized Official

Name: DR. VALRIE M. HONABLUE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 404-402-6076