Healthcare Provider Details

I. General information

NPI: 1831422567
Provider Name (Legal Business Name): PERIMETER SPINE & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 PEACHTREE DUNWOODY RD NE SUITE 100
ATLANTA GA
30328-1689
US

IV. Provider business mailing address

7100 PEACHTREE DUNWOODY RD NE STE 100
ATLANTA GA
30328-1689
US

V. Phone/Fax

Practice location:
  • Phone: 770-392-9299
  • Fax: 770-392-9298
Mailing address:
  • Phone: 770-392-9299
  • Fax: 770-392-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number038955
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number038955
License Number StateGA

VIII. Authorized Official

Name: DR. ATLEE WAMPLER IV
Title or Position: PRESIDENT
Credential:
Phone: 770-392-9299