Provider Demographics
NPI:1871675470
Name:SOUTHERN REGIONAL ACCIDENT & INJURY INC.
Entity Type:Organization
Organization Name:SOUTHERN REGIONAL ACCIDENT & INJURY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-991-1227
Mailing Address - Street 1:PO BOX 550029
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-2529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 UPPER RIVERDALE RD SE
Practice Address - Street 2:SUITE 100D
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2635
Practice Address - Country:US
Practice Address - Phone:770-991-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty