1215273974 NPI number — BUCKHEAD INJURY AND WELLNESS INSTITUTE PC


Table of content for BUCKHEAD INJURY AND WELLNESS INSTITUTE PC (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):
Provider Organization Name:BUCKHEAD INJURY AND WELLNESS INSTITUTE PC
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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
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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
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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 .

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