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General NPI Number Information
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NPI Number | 1881035194
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Entity Type | Organization
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Legal Business Name | PABS UNLIMITED, INC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 4405 MALL BLVD STE 200
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City | UNION CITY
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State | GA
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Zip | 30291-2071
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Country | US
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Telephone | 770-969-4309
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Fax | 770-969-4170
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Provider Business Mailing Address
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Address Line | 4405 MALL BLVD STE 200
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City | UNION CITY
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State | GA
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Zip | 30291-2071
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Country | US
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Telephone | 770-969-4309
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Fax | 770-969-4170
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. DWIGHT ALONZO PORTER
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Credential | L.P.C., ED.S.
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Telephone | 770-969-4309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 006366
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License Number State | GA
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