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General NPI Number Information
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NPI Number | 1457866444
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Entity Type | Individual
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Provider Name | LOVEL PHADAEL RCP
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Gender | Male
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 1109 GREEN ST
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City | ROSWELL
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State | GA
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Zip | 30075-3609
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Country | US
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Telephone | 770-998-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 MULBERRY LN
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City | LITHONIA
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State | GA
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Zip | 30058-6791
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Country | US
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Telephone | 404-452-9872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 6569
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License Number State | GA
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