MEDICARE: GEORGIA ABNER OTR/L

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
1	171W00000X	Contractor	OTR 350	AR

General Provider Information

NPI Number	:	1629340047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA ABNER OTR/L

Provider Business Mailing Address
First Line	:	6007 MANDAN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6007 MANDAN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-3046
Country	:	US
Telephone Number	:	501-412-6769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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