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NPI Code Detail

MEDICARE: AFEAGA IZIEGBE HAMLETT MS, RBT

MEDICARE: AFEAGA IZIEGBE HAMLETT MS, RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-20-137948GA

General Provider Information

NPI Number : 1487252904
Entity Type Code : Individual
Provider Name (Legal Business Name) : AFEAGA IZIEGBE HAMLETT MS, RBT
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4920 ROSWELL RD STE 1
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2684
Country : US
Telephone Number : 470-258-4163
Fax Number : 470-208-2364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2020
Last Update Date : 09/15/2021

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