Provider Demographics
NPI:1467630384
Name:THE HAND AND UPPER EXTREMITY REHABILITATION CENTER
Entity Type:Organization
Organization Name:THE HAND AND UPPER EXTREMITY REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:404-255-1242
Mailing Address - Street 1:980 JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 1000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-255-1242
Mailing Address - Fax:404-256-4669
Practice Address - Street 1:3400 OLD MILTON PKWY # A
Practice Address - Street 2:STE 350
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:404-693-9098
Practice Address - Fax:404-693-9070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HAND AND UPPER EXTREMITY REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0700009309225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7700OtherGROUP #