Provider Demographics
NPI:1861473274
Name:ATLANTA INSTITUTE OF MEDICINE AND REHABILITATION
Entity Type:Organization
Organization Name:ATLANTA INSTITUTE OF MEDICINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EPPELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-365-0160
Mailing Address - Street 1:2911 PIEDMONT RD NE
Mailing Address - Street 2:STE E
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2783
Mailing Address - Country:US
Mailing Address - Phone:404-365-0160
Mailing Address - Fax:404-365-0751
Practice Address - Street 1:2911 PIEDMONT RD NE
Practice Address - Street 2:STE E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2783
Practice Address - Country:US
Practice Address - Phone:404-365-0160
Practice Address - Fax:404-365-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038830207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDJHCMedicare ID - Type Unspecified
F99281Medicare UPIN