Provider Demographics
NPI:1487838900
Name:SPINE CENTER ATLANTA REHABILITATION & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SPINE CENTER ATLANTA REHABILITATION & WELLNESS CENTER, LLC
Other - Org Name:SPINE CENTER ATLANTA, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:MARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-352-4200
Mailing Address - Street 1:3161 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2117
Mailing Address - Country:US
Mailing Address - Phone:404-352-4200
Mailing Address - Fax:404-352-5200
Practice Address - Street 1:3161 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 410
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2117
Practice Address - Country:US
Practice Address - Phone:404-352-4200
Practice Address - Fax:404-352-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy