Healthcare Provider Details

I. General information

NPI: 1528505799
Provider Name (Legal Business Name): PROJECT REBOUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 FRANCIS ST
COLUMBUS GA
31906-2512
US

IV. Provider business mailing address

2833 MIMOSA ST
COLUMBUS GA
31906-2163
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-4830
  • Fax: 706-622-3030
Mailing address:
  • Phone: 706-221-4830
  • Fax: 706-622-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number070267
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number062999
License Number StateGA

VIII. Authorized Official

Name: AMIN ALEEM
Title or Position: CFO
Credential:
Phone: 706-221-4830