Healthcare Provider Details

I. General information

NPI: 1578622593
Provider Name (Legal Business Name): ATLANTA PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 BUFORD HWY SUITE 201
CHAMBLEE GA
30341-3535
US

IV. Provider business mailing address

4961 BUFORD HWY SUITE 201
CHAMBLEE GA
30341-3535
US

V. Phone/Fax

Practice location:
  • Phone: 404-575-4000
  • Fax: 404-575-4010
Mailing address:
  • Phone: 404-575-4000
  • Fax: 404-575-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ROSERO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 404-575-4000