Provider Demographics
NPI:1215470786
Name:OSBORNE, PAULA RENE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:RENE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 PEACHTREE CORNERS CIR
Mailing Address - Street 2:APT. Q
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3692
Mailing Address - Country:US
Mailing Address - Phone:770-572-0958
Mailing Address - Fax:
Practice Address - Street 1:3365 PEACHTREE CORNERS CIR
Practice Address - Street 2:APT. Q
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3692
Practice Address - Country:US
Practice Address - Phone:770-572-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician