Provider Demographics
NPI:1285029884
Name:HHSRC NEUROMUSCULAR
Entity Type:Organization
Organization Name:HHSRC NEUROMUSCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NEUROMUSCULAR THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDDLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-778-2109
Mailing Address - Street 1:5474 OAKLEY INDUSTRIAL BLVD
Mailing Address - Street 2:APT 1032
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4455
Mailing Address - Country:US
Mailing Address - Phone:678-778-2109
Mailing Address - Fax:770-774-4232
Practice Address - Street 1:5474 OAKLEY INDUSTRIAL BLVD
Practice Address - Street 2:APT. 1032
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4455
Practice Address - Country:US
Practice Address - Phone:678-778-2109
Practice Address - Fax:770-774-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002021320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities