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General NPI Number Information
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NPI Number | 1740561125
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Entity Type | Organization
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Legal Business Name | JBLB HOLDINGS, LLC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 400 PERIMETER CENTER TER NORTH SUITE 900
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City | ATLANTA
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State | GA
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Zip | 30346
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Country | US
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Telephone | 404-574-1945
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Fax | 800-809-6184
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Provider Business Mailing Address
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Address Line | 8343 ROSWELL RD # 283
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City | ATLANTA
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State | GA
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Zip | 30350-2810
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Country | US
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Telephone | 404-574-1945
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Fax | 800-809-6184
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN BERBERIAN
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Credential | DC
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Telephone | 404-574-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number | H7626
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License Number State | TX
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