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General NPI Number Information
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NPI Number | 1265235733
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Entity Type | Organization
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Legal Business Name | PHOENIX WELLNESS AND REHABIILITATION SERVICES
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 2959 HERRON LN SW
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City | ATLANTA
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State | GA
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Zip | 30349-1501
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Country | US
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Telephone | 678-591-3873
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Fax |
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Provider Business Mailing Address
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Address Line | 2959 HERRON LN SW
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City | ATLANTA
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State | GA
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Zip | 30349-1501
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Country | US
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Telephone | 678-591-3873
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATRISHA MCCAULEY
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Credential | DC
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Telephone | 678-591-3873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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