Provider Demographics
NPI:1821535089
Name:SOUTHWEST ATLANTA MEDICAL & REHAB
Entity Type:Organization
Organization Name:SOUTHWEST ATLANTA MEDICAL & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-705-1733
Mailing Address - Street 1:1203 CLEVELAND AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:678-705-1733
Mailing Address - Fax:678-573-5039
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:STE 1A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:678-705-1733
Practice Address - Fax:678-573-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty