Provider Demographics
NPI:1164561288
Name:ADVANCED THERAPY GROUP INC.
Entity Type:Organization
Organization Name:ADVANCED THERAPY GROUP INC.
Other - Org Name:ADVANCED THERAPY GROUP INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-261-0328
Mailing Address - Street 1:1266 W PACES FERRY RD NW
Mailing Address - Street 2:STE 664
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2306
Mailing Address - Country:US
Mailing Address - Phone:404-261-0328
Mailing Address - Fax:404-842-0878
Practice Address - Street 1:49 BENNETT ST NW
Practice Address - Street 2:STE D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-5217
Practice Address - Country:US
Practice Address - Phone:404-467-7780
Practice Address - Fax:404-842-0878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED THERAPY GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA083575LGB261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116826Medicare Oscar/Certification