Healthcare Provider Details

I. General information

NPI: 1811303928
Provider Name (Legal Business Name): PERIMETER HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 HIGHWAY 317 STE 12-318
SUWANEE GA
30024-2649
US

IV. Provider business mailing address

1140 HAMMOND DR SUITE 110, BLDG K
ATLANTA GA
30328-5338
US

V. Phone/Fax

Practice location:
  • Phone: 678-730-6240
  • Fax: 678-730-0280
Mailing address:
  • Phone: 770-454-8300
  • Fax: 678-730-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA SHELTON
Title or Position: OPERATIONS MGR
Credential:
Phone: 678-730-6240