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Individual

DR. DANIELLE IBELEMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
4062 PEACHTREE RD NE STE A-536, BROOKHAVEN, GA 30319-3021
(678) 322-8138
Mailing address
4062 PEACHTREE RD NE STE A-536, BROOKHAVEN, GA 30319-3021
(678) 827-5797

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
76263
GA
2080A0000X
Pediatric Adolescent Medicine Physician
076263
GA
2084P0800X
Psychiatry Physician
76263
GA
2084P0804X
Child & Adolescent Psychiatry Physician
76263
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
076263
MEDICAL LICENSE
GA
Enumeration date
05/27/2011
Last updated
01/13/2021
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