Provider Demographics
NPI:1497051619
Name:CHBW MEDICAL &REHAB CLINIC
Entity Type:Organization
Organization Name:CHBW MEDICAL &REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:IDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-7033
Mailing Address - Street 1:2636 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1634
Mailing Address - Country:US
Mailing Address - Phone:770-256-7033
Mailing Address - Fax:678-705-3717
Practice Address - Street 1:2636 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1634
Practice Address - Country:US
Practice Address - Phone:770-256-7033
Practice Address - Fax:678-705-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care