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General NPI Number Information
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NPI Number | 1669614343
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Entity Type | Organization
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Legal Business Name | HARLEY ANTI-AGING INSTITUTE LLC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 1800 PEACHTREE ST NW SUITE 455
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City | ATLANTA
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State | GA
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Zip | 30309-2519
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Country | US
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Telephone | 678-500-1066
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Fax | 678-500-1067
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Provider Business Mailing Address
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Address Line | 1800 PEACHTREE ST NW SUITE 455
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City | ATLANTA
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State | GA
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Zip | 30309-2519
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Country | US
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Telephone | 678-500-1066
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Fax | 678-500-1067
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SHARON A BENT-HARLEY
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Credential | M.D.
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Telephone | 678-500-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 028500
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License Number State | GA
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