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General NPI Number Information
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NPI Number | 1841578853
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTA MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 2643 CALDWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30319-3118
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Country | US
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Telephone | 678-328-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 CALDWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30319-3118
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Country | US
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Telephone | 678-328-0577
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RAKESH KOTHARI
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Credential | DC
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Telephone | 678-328-0577
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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 | CHIR007845
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036662
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License Number State | GA
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