1215273974 NPI number — BUCKHEAD INJURY AND WELLNESS INSTITUTE PC

Table of content: (NPI 1215273974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215273974 NPI number — BUCKHEAD INJURY AND WELLNESS INSTITUTE PC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
BUCKHEAD INJURY AND WELLNESS INSTITUTE PC
Provider Last Name:
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Provider Gender Code:

Provider's Other Name Information

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NPI Number Information

NPI Number:
1215273974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5825 GLENRIDGE DR NE STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 GLENRIDGE DR NE STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-779-3903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LIONEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
770-439-7575

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  27927 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)