Provider Demographics
NPI:1003670282
Name:ATL PELVIC HEALTH
Entity Type:Organization
Organization Name:ATL PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MOISE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:615-554-1415
Mailing Address - Street 1:1145 ZONOLITE RD NE STE 8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2017
Mailing Address - Country:US
Mailing Address - Phone:404-890-0212
Mailing Address - Fax:
Practice Address - Street 1:1145 ZONOLITE RD NE STE 8
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2017
Practice Address - Country:US
Practice Address - Phone:404-890-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy