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General NPI Number Information
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NPI Number | 1285967489
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Entity Type | Organization
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Legal Business Name | BARRACK SPINE AND JOINT MEDICINE, INC.
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 1230 JOHNSON FERRY PL SUITE H-15/20
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City | MARIETTA
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State | GA
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Zip | 30068-2048
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Country | US
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Telephone | 678-738-7601
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Fax | 678-738-7605
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Provider Business Mailing Address
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Address Line | 1230 JOHNSON FERRY PL SUITE H-15/20
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City | MARIETTA
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State | GA
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Zip | 30068-2048
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Country | US
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Telephone | 678-738-7601
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Fax | 678-738-7605
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LATASHA LYMAN
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Credential |
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Telephone | 678-738-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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