Provider Demographics
NPI:1003067828
Name:PERFORMANCE INJURY CENTER LLC.
Entity Type:Organization
Organization Name:PERFORMANCE INJURY CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINTOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-296-4888
Mailing Address - Street 1:4294 MEMORIAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1226
Mailing Address - Country:US
Mailing Address - Phone:404-296-4888
Mailing Address - Fax:404-296-8811
Practice Address - Street 1:4294 MEMORIAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1226
Practice Address - Country:US
Practice Address - Phone:404-296-4888
Practice Address - Fax:404-296-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2973111N00000X
GA038164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty