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General NPI Number Information
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NPI Number | 1063671915
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTA MEDICAL AND REHABILITATION, LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 288 HIGHWAY 314 SUITE C
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7830
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Country | US
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Telephone | 678-817-4053
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Fax | 678-817-4058
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Provider Business Mailing Address
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Address Line | 288 HIGHWAY 314 SUITE C
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7830
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Country | US
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Telephone | 678-817-4053
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Fax | 678-817-4058
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | JOSHUA D LEWIS
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Credential |
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Telephone | 678-943-2697
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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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