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General NPI Number Information
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NPI Number | 1467579144
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Entity Type | Organization
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Legal Business Name | SOUTHCARE SPINAL REHAB
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6017 WESTERN HILLS DR SUITE 105
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City | NORCROSS
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State | GA
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Zip | 30071-3483
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Country | US
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Telephone | 770-409-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 6017 WESTERN HILLS DRIVE SUITE 105
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City | NORCROSS
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State | GA
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Zip | 30071-3483
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Country | US
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Telephone | 770-409-0450
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. MICHAEL I COHEN
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Credential | DC
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Telephone | 770-409-0450
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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 | CHIR005882
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License Number State | GA
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