Provider Demographics
NPI:1790018554
Name:DREAM MEDICAL & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:DREAM MEDICAL & REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:770-955-3501
Mailing Address - Street 1:2024 POWERS FERRY RD SE
Mailing Address - Street 2:STE# 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5011
Mailing Address - Country:US
Mailing Address - Phone:770-955-3501
Mailing Address - Fax:770-955-3505
Practice Address - Street 1:2024 POWERS FERRY RD. SE
Practice Address - Street 2:STE# 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-955-3501
Practice Address - Fax:770-955-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007731111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty