Healthcare Provider Details

I. General information

NPI: 1851569396
Provider Name (Legal Business Name): ANDREA MICHELLE CHARBENEAU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 LENOX RD NE SUITE 120
ATLANTA GA
30324-6006
US

IV. Provider business mailing address

2770 LENOX RD NE SUITE 120
ATLANTA GA
30324-6006
US

V. Phone/Fax

Practice location:
  • Phone: 404-364-9551
  • Fax: 404-261-0617
Mailing address:
  • Phone: 404-364-9551
  • Fax: 404-261-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009144
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: