Provider Demographics
NPI:1871502229
Name:ATLANTA HUMAN PERFORMANCE CENTER
Entity Type:Organization
Organization Name:ATLANTA HUMAN PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PT, DPT
Authorized Official - Phone:404-346-1526
Mailing Address - Street 1:3250 HOGAN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2830
Mailing Address - Country:US
Mailing Address - Phone:404-346-1526
Mailing Address - Fax:404-346-0729
Practice Address - Street 1:3250 HOGAN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2830
Practice Address - Country:US
Practice Address - Phone:404-346-1526
Practice Address - Fax:404-346-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA487664757AMedicare ID - Type Unspecified