Healthcare Provider Details

I. General information

NPI: 1912988098
Provider Name (Legal Business Name): INJURY PREVENTION & MANAGEMENT CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY PARK SUITE 121
ATLANTA GA
30338-6202
US

IV. Provider business mailing address

4514 CHAMBLEE DUNWOODY RD SUITE 140
ATLANTA GA
30338-6202
US

V. Phone/Fax

Practice location:
  • Phone: 404-966-9181
  • Fax: 770-394-4110
Mailing address:
  • Phone: 404-966-9181
  • Fax: 404-249-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT005771
License Number StateGA

VIII. Authorized Official

Name: MR. MARC ALAN YEAGER
Title or Position: PRESIDENT - PRINCIPLE
Credential: PT
Phone: 404-966-9181