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General NPI Number Information
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NPI Number | 1063945947
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Entity Type | Organization
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Legal Business Name | INJURY AND REHAB CENTERS OF GEORGIA, LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 1568 INDIAN TRAIL LILBURN RD STE 105
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City | NORCROSS
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State | GA
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Zip | 30093-2613
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Country | US
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Telephone | 770-696-2404
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Fax | 770-696-2135
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Provider Business Mailing Address
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Address Line | 1568 INDIAN TRAIL LILBURN RD STE 105
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City | NORCROSS
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State | GA
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Zip | 30093-2613
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Country | US
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Telephone | 770-696-2404
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Fax | 770-696-2135
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Authorized Official
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Title or Position | PARTNER
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Name | MARIA LEYVA-IZAGUIRRE
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Credential |
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Telephone | 770-696-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR005705
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License Number State | GA
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