Provider Demographics
NPI:1073160404
Name:SOUTH ATLANTA JOINT & REHAB
Entity Type:Organization
Organization Name:SOUTH ATLANTA JOINT & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:877-495-7773
Mailing Address - Street 1:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-1601
Mailing Address - Country:US
Mailing Address - Phone:334-298-7700
Mailing Address - Fax:
Practice Address - Street 1:541 FOREST PKWY STE 14
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6110
Practice Address - Country:US
Practice Address - Phone:706-404-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHENIX CITY JOINT & REHAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty