Provider Demographics
NPI:1801194022
Name:PERIMETER SPINE AND REHABILITATION LLC
Entity Type:Organization
Organization Name:PERIMETER SPINE AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATLEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:770-392-9299
Mailing Address - Street 1:PO BOX 566516
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31156-6516
Mailing Address - Country:US
Mailing Address - Phone:770-392-9299
Mailing Address - Fax:
Practice Address - Street 1:7100 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1689
Practice Address - Country:US
Practice Address - Phone:770-392-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty