Provider Demographics
NPI:1659655132
Name:SOUTH METRO REHAB AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:SOUTH METRO REHAB AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:770-876-5776
Mailing Address - Street 1:3159 PANTHERS TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3855
Mailing Address - Country:US
Mailing Address - Phone:770-876-5776
Mailing Address - Fax:
Practice Address - Street 1:245 VILLAGE CENTER PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9096
Practice Address - Country:US
Practice Address - Phone:770-876-5776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty