Provider Demographics
NPI:1740566181
Name:PHYSICAL MEDICINE OF NORCROSS
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE OF NORCROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-416-9995
Mailing Address - Street 1:6315 SPAULDING DR STE B
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4653
Mailing Address - Country:US
Mailing Address - Phone:770-416-9995
Mailing Address - Fax:770-416-6777
Practice Address - Street 1:6315 SPAULDING DR STE B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4653
Practice Address - Country:US
Practice Address - Phone:770-416-9995
Practice Address - Fax:770-416-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063309261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain