Provider Demographics
NPI:1558702308
Name:BUCKHEAD INSTITUTE OF MEDICINE & REHABILITATION INC.
Entity Type:Organization
Organization Name:BUCKHEAD INSTITUTE OF MEDICINE & REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VLADIMIROVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-365-0160
Mailing Address - Street 1:2911 PIEDMONT RD NE STE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2783
Mailing Address - Country:US
Mailing Address - Phone:404-365-0160
Mailing Address - Fax:404-365-0751
Practice Address - Street 1:2911 PIEDMONT RD NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2783
Practice Address - Country:US
Practice Address - Phone:404-365-0160
Practice Address - Fax:404-365-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty