Healthcare Provider Details

I. General information

NPI: 1063805091
Provider Name (Legal Business Name): SOUTHWEST ATLANTA MEDICAL & REHABILITATION CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 85 CIRCLE SUITE 100
ATLANTA GA
30349
US

IV. Provider business mailing address

495 85 CIRCLE SUITE 100
ATLANTA GA
30349
US

V. Phone/Fax

Practice location:
  • Phone: 678-705-1733
  • Fax: 678-573-5039
Mailing address:
  • Phone: 678-705-1733
  • Fax: 678-573-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DALE A CAREY
Title or Position: OWNER
Credential: D.O.
Phone: 678-705-1733