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General NPI Number Information
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NPI Number | 1275878381
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Entity Type | Organization
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Legal Business Name | CEDARCREST MEDICAL AND REHABILITATION
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 2161 CEDARCREST RD 115
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City | ACWORTH
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State | GA
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Zip | 30101-6404
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Country | US
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Telephone | 678-574-4878
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Fax | 678-574-4899
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Provider Business Mailing Address
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Address Line | 2161 CEDARCREST RD 115
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City | ACWORTH
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State | GA
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Zip | 30101-6404
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Country | US
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Telephone | 678-574-4878
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Fax | 678-574-4899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE A BUENO
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Credential | D.C
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Telephone | 678-574-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 007057
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License Number State | GA
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