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General NPI Number Information
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NPI Number | 1013042712
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANT MEDICAL& REHABILITATION, L.L.C.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 1711 WASHINGTON AVE
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City | EAST POINT
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State | GA
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Zip | 30344-4115
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Country | US
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Telephone | 404-767-7474
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Fax | 404-767-7707
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Provider Business Mailing Address
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Address Line | 1711 WASHINGTON AVE
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City | EAST POINT
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State | GA
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Zip | 30344-4115
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Country | US
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Telephone | 404-767-7474
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Fax | 404-767-7707
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN BRADLEY BRUNET
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Credential | D.C.
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Telephone | 678-817-4053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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