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General NPI Number Information
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NPI Number | 1619140753
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Entity Type | Organization
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Legal Business Name | BUSINESS INTELLIGENCE TECHNOLOGY
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 923 COMMERCIAL ST NE
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City | CONYERS
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State | GA
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Zip | 30012-4537
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Country | US
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Telephone | 770-982-2103
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Fax | 770-760-8870
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Provider Business Mailing Address
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Address Line | 335 MCKEES ROCK LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5005
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Country | US
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Telephone | 770-982-2103
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Fax | 770-982-2103
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | BRIAN CONTON
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Credential | PT, MBA
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Telephone | 770-982-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT006109
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License Number State | GA
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