Provider Demographics
NPI:1619456019
Name:ATLANTA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ATLANTA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT, SDN
Authorized Official - Phone:516-480-8434
Mailing Address - Street 1:338 HILLCREST AVE APT E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2068
Mailing Address - Country:US
Mailing Address - Phone:404-390-0255
Mailing Address - Fax:
Practice Address - Street 1:338 HILLCREST AVE APT E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2068
Practice Address - Country:US
Practice Address - Phone:404-390-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012845261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy