Healthcare Provider Details

I. General information

NPI: 1528852944
Provider Name (Legal Business Name): GEORGIA INJURY CENTER OF CHAMBLEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 PEACHTREE BLVD STE 102
CHAMBLEE GA
30341-3250
US

IV. Provider business mailing address

3011 SUTTON GATE DR STE 210
SUWANEE GA
30024-5153
US

V. Phone/Fax

Practice location:
  • Phone: 678-730-6240
  • Fax:
Mailing address:
  • Phone: 678-730-6240
  • Fax: 678-730-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX JUTIS
Title or Position: CEO
Credential:
Phone: 678-730-6240