Healthcare Provider Details

I. General information

NPI: 1013261833
Provider Name (Legal Business Name): ATLANTA PAIN SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 POWERS FERRY RD SE SUITE 100
MARIETTA GA
30067-5442
US

IV. Provider business mailing address

2009 WHITTIER AVE NW
ATLANTA GA
30318-1030
US

V. Phone/Fax

Practice location:
  • Phone: 412-401-7905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008149
License Number StateGA

VIII. Authorized Official

Name: DR. DALE JOSEPH LEBDER
Title or Position: CEO / CLINIC DIRECTOR
Credential: D.C.
Phone: 412-401-7905