Healthcare Provider Details

I. General information

NPI: 1497214308
Provider Name (Legal Business Name): HORNER MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

3578 INMAN DR NE
BROOKHAVEN GA
30319-2432
US

V. Phone/Fax

Practice location:
  • Phone: 678-401-3803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL HORNER
Title or Position: PHYSICIAN
Credential: MD
Phone: 678-701-2225