Provider Demographics
NPI:1619591450
Name:PALLONE, BRIAN (AT, C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PALLONE
Suffix:
Gender:M
Credentials:AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-4642
Mailing Address - Country:US
Mailing Address - Phone:770-337-2299
Mailing Address - Fax:
Practice Address - Street 1:2801 N DECATUR RD STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5936
Practice Address - Country:US
Practice Address - Phone:404-296-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant