Provider Demographics
NPI:1669638698
Name:REHAB OF BUCKHEAD
Entity Type:Organization
Organization Name:REHAB OF BUCKHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-795-0506
Mailing Address - Street 1:PO BOX 671962
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0033
Mailing Address - Country:US
Mailing Address - Phone:770-795-0506
Mailing Address - Fax:
Practice Address - Street 1:3165 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1851
Practice Address - Country:US
Practice Address - Phone:770-795-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty