1265710149 NPI number — MEDREHAB SPECIALISTS PA

Table of content: (NPI 1265710149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265710149 NPI number — MEDREHAB SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDREHAB SPECIALISTS 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:
1265710149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
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
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30346-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-596-5599
Provider Business Mailing Address Fax Number:
888-508-2509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 PERIMETER CTR N
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30346-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-596-5599
Provider Business Practice Location Address Fax Number:
888-508-2509
Provider Enumeration Date:
07/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOREJON
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
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)

  • Identifier: 003115372A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DS1707 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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