Healthcare Provider Details

I. General information

NPI: 1871100479
Provider Name (Legal Business Name): PRODUCTION PHYSICOS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 SANDY CREEK RD STE 1102
FAYETTEVILLE GA
30214-4284
US

IV. Provider business mailing address

1229 JOHNSON FERRY RD STE 202
MARIETTA GA
30068-5416
US

V. Phone/Fax

Practice location:
  • Phone: 470-275-5015
  • Fax: 623-239-0100
Mailing address:
  • Phone: 470-275-5015
  • Fax: 623-239-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHERRI LIPSCOMB
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-275-5015