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General NPI Number Information
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NPI Number | 1952985509
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Entity Type | Organization
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Legal Business Name | ADVANCE THERAPEUTICS, LLC
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 2950 STONE HOGAN CONNECTOR RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-2837
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Country | US
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Telephone | 404-781-2800
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Fax | 833-897-2947
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Provider Business Mailing Address
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Address Line | 150 MEDICAL BLVD STE C
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5053
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Country | US
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Telephone | 404-781-2800
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Fax | 833-897-2947
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Authorized Official
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Title or Position | CREDENTIALING LIASION
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Name | REASONS WESTON
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Credential |
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Telephone | 404-552-1049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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