Provider Demographics
NPI:1063671915
Name:SOUTH ATLANTA MEDICAL AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:SOUTH ATLANTA MEDICAL AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-943-2697
Mailing Address - Street 1:288 HIGHWAY 314
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7830
Mailing Address - Country:US
Mailing Address - Phone:678-817-4053
Mailing Address - Fax:678-817-4058
Practice Address - Street 1:288 HIGHWAY 314
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7830
Practice Address - Country:US
Practice Address - Phone:678-817-4053
Practice Address - Fax:678-817-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty