Healthcare Provider Details

I. General information

NPI: 1235402926
Provider Name (Legal Business Name): PAUL EGBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2012
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 EMPORIA LOOP
MCDONOUGH GA
30253-6904
US

IV. Provider business mailing address

PO BOX 2533
MCDONOUGH GA
30253-1737
US

V. Phone/Fax

Practice location:
  • Phone: 470-540-0107
  • Fax:
Mailing address:
  • Phone: 334-545-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3002
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006777
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3002
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: