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General NPI Number Information
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NPI Number | 1063238749
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Entity Type | Organization
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Legal Business Name | PREMIER INJURY SPECIALIST
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1035 SOUTHCREST DR STE 120
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6120
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Country | US
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Telephone | 678-464-3078
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2811
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-0811
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Country | US
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Telephone | 678-464-3078
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHNNY BROWN
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Credential |
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Telephone | 678-464-3078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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