Healthcare Provider Details

I. General information

NPI: 1558679332
Provider Name (Legal Business Name): ATLANTA ACCIDENT & INJURY SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 NORTHLAKE PKWY. SUITE 120 BLDG 6
TUCKER GA
30084
US

IV. Provider business mailing address

P.O. BOX 267
TUCKER GA
30085
US

V. Phone/Fax

Practice location:
  • Phone: 770-934-4233
  • Fax: 770-934-4234
Mailing address:
  • Phone: 770-934-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO07460
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038164
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30996
License Number StateGA

VIII. Authorized Official

Name: DANA GENE PICCIRILLO
Title or Position: OWNER
Credential: D.C
Phone: 770-934-4233