Provider Demographics
NPI:1689918310
Name:ATLANTA PAIN REHABILITATION MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ATLANTA PAIN REHABILITATION MANAGEMENT, LLC
Other - Org Name:ATLANTA PAIN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-228-2587
Mailing Address - Street 1:2950 STONE HOGAN ROAD CONN,
Mailing Address - Street 2:BLDG 3 SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331
Mailing Address - Country:US
Mailing Address - Phone:404-228-2587
Mailing Address - Fax:
Practice Address - Street 1:2950 STONE HOGAN RD
Practice Address - Street 2:BLDG 3 SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2837
Practice Address - Country:US
Practice Address - Phone:404-228-2587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156887261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty