=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528479326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBOUND INTEGRATIVE MEDICAL GROUP PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 289 JONESBORO RD SUITE 343
-----------------------------------------------------
City | MCDONOUGH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30253-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-898-8408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 289 JONESBORO RD SUITE 343
-----------------------------------------------------
City | MCDONOUGH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30253-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-898-8408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. AMIN ALEEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-721-3609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------