Provider Demographics
NPI:1811202989
Name:EAGLES LANDING PAIN & REHAB
Entity Type:Organization
Organization Name:EAGLES LANDING PAIN & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIE
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:770-455-4600
Mailing Address - Street 1:125 EAGLE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6328
Mailing Address - Country:US
Mailing Address - Phone:678-379-0943
Mailing Address - Fax:678-379-0945
Practice Address - Street 1:3286 BUCKEYE RD STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4228
Practice Address - Country:US
Practice Address - Phone:770-455-4600
Practice Address - Fax:770-455-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006333CHIRO111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty