Provider Demographics
NPI:1225129638
Name:ATLANTA PHYSICAL THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:ATLANTA PHYSICAL THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-252-7513
Mailing Address - Street 1:709 OLD BURTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-1142
Mailing Address - Country:US
Mailing Address - Phone:706-947-1058
Mailing Address - Fax:706-947-0109
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 1040
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-252-7513
Practice Address - Fax:706-947-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1093225100000X, 2251H1200X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52885735OtherBCBS PROVDER #
GA65BBBPRMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
GAGRP4199Medicare ID - Type UnspecifiedMEDICARE GROUP #