Healthcare Provider Details

I. General information

NPI: 1043577653
Provider Name (Legal Business Name): MRS. DEBRA S HALBIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 FOUR WINDS DR SW
LILBURN GA
30047-6420
US

IV. Provider business mailing address

5760 FOUR WINDS DR SW
LILBURN GA
30047-6420
US

V. Phone/Fax

Practice location:
  • Phone: 770-717-1063
  • Fax:
Mailing address:
  • Phone: 770-717-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH016651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: