Provider Demographics
NPI:1407861826
Name:THE ARISTOS HEALTH GROUP, LLC.
Entity Type:Organization
Organization Name:THE ARISTOS HEALTH GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALLINGTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-739-1177
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1008
Mailing Address - Country:US
Mailing Address - Phone:770-739-1177
Mailing Address - Fax:866-552-8286
Practice Address - Street 1:2787 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4039
Practice Address - Country:US
Practice Address - Phone:770-739-1177
Practice Address - Fax:866-552-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA826410134AMedicaid
GA826410134AMedicaid