Healthcare Provider Details

I. General information

NPI: 1801089917
Provider Name (Legal Business Name): 1ST CHOICE HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHURCH ST
DECATUR GA
30030-1527
US

IV. Provider business mailing address

1423 CHURCH ST
DECATUR GA
30030-1527
US

V. Phone/Fax

Practice location:
  • Phone: 404-377-0011
  • Fax: 404-377-0760
Mailing address:
  • Phone: 404-377-0011
  • Fax: 404-377-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR002615
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009017
License Number StateGA

VIII. Authorized Official

Name: DR. HAMID SADRI
Title or Position: OFFICER
Credential: D.C., C.C.S.P.
Phone: 404-377-0011