Healthcare Provider Details

I. General information

NPI: 1629688114
Provider Name (Legal Business Name): PRM OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 E PACES FERRY RD NE STE 730
ATLANTA GA
30305-2372
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 700
WEST PALM BEACH FL
33409-6508
US

V. Phone/Fax

Practice location:
  • Phone: 470-322-4113
  • Fax:
Mailing address:
  • Phone: 561-805-3880
  • Fax: 561-318-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SOLIMINE
Title or Position: VP OF OPERATIONS
Credential:
Phone: 561-805-3873