Healthcare Provider Details

I. General information

NPI: 1164713723
Provider Name (Legal Business Name): PAUL N HORNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 SPRING ST NW
ATLANTA GA
30308-1934
US

IV. Provider business mailing address

688 SPRING ST NW
ATLANTA GA
30308-1934
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-1155
  • Fax:
Mailing address:
  • Phone: 404-881-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number77380
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: