1861473274 NPI number — ATLANTA INSTITUTE OF MEDICINE AND REHABILITATION

Table of content: (NPI 1861473274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861473274 NPI number — ATLANTA INSTITUTE OF MEDICINE AND REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA INSTITUTE OF MEDICINE AND REHABILITATION
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:
1861473274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 PIEDMONT RD NE
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-2783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-365-0160
Provider Business Mailing Address Fax Number:
404-365-0751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 PIEDMONT RD NE
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30305-2783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-365-0160
Provider Business Practice Location Address Fax Number:
404-365-0751
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EPPELBAUM
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-365-0160

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  038830 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208VP0014X , with the licence number: 038830 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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