=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669652095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN M HARBEN M.D.,PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 12/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11775 POINTE PLACE SUITE 103
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-619-0010
-----------------------------------------------------
Fax | 770-664-6511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11775 POINTE PL SUITE 103
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-619-0010
-----------------------------------------------------
Fax | 770-664-6511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 029664
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 029664
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------