=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811132368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION MEDICINE AND EMG CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2008
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 MEDICAL BLVD
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-5086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-284-4000
-----------------------------------------------------
Fax | 678-284-6500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 MEDICAL BLVD
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-5086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-284-4000
-----------------------------------------------------
Fax | 678-284-6500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. D TERRENCE FOSTER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 678-284-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number | 049232
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------