Provider Demographics
NPI:1225204423
Name:SOUTH FULTON MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH FULTON MEDICAL CENTER, LLC
Other - Org Name:SOUTH FULTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-761-0332
Mailing Address - Street 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-761-0332
Mailing Address - Fax:404-763-0135
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 406
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-761-0332
Practice Address - Fax:404-763-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007116111NR0400X
GACHIR006333111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty