1366815896 NPI number — MEDREHAB SPECIALISTS OF NORTH CAROLINA PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366815896 NPI number — MEDREHAB SPECIALISTS OF NORTH CAROLINA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDREHAB SPECIALISTS OF NORTH CAROLINA PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366815896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 PERIMETER CTR N STE 300
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:
30346-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-626-2505
Provider Business Mailing Address Fax Number:
704-626-2505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 EBENEZER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-626-2505
Provider Business Practice Location Address Fax Number:
704-626-2505
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MOREJON
Authorized Official First Name:
SUZETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
404-596-5599

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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