Healthcare Provider Details

I. General information

NPI: 1871502229
Provider Name (Legal Business Name): ATLANTA HUMAN PERFORMANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 HOGAN RD SW
ATLANTA GA
30331-2830
US

IV. Provider business mailing address

3250 HOGAN RD SW
ATLANTA GA
30331-2830
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-1526
  • Fax: 404-346-0729
Mailing address:
  • Phone: 404-346-1526
  • Fax: 404-346-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000168
License Number StateGA

VIII. Authorized Official

Name: DR. KEITH E EVANS
Title or Position: DIRECTOR/OWNER
Credential: MD, PT, DPT
Phone: 404-346-1526