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General NPI Number Information
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NPI Number | 1972924686
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER FOR PAIN, INJURY & REHAB, LLC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 2400 PLEASANT HILL RD STE 300
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City | DULUTH
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State | GA
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Zip | 30096-4398
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Country | US
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Telephone | 678-465-7092
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Fax | 678-832-1528
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Provider Business Mailing Address
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Address Line | 2400 PLEASANT HILL RD STE 300
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City | DULUTH
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State | GA
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Zip | 30096-4398
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Country | US
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Telephone | 678-465-7092
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Fax | 678-832-1528
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR-CLINIC DIRECTOR
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Name | DR. ROLANDO TALLEDO
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Credential | D.C.
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Telephone | 678-465-7092
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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 | CHIR009067
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License Number State | GA
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