Provider Demographics
NPI:1891886347
Name:ADVANCED INJURY AND REHAB CENTER
Entity Type:Organization
Organization Name:ADVANCED INJURY AND REHAB CENTER
Other - Org Name:ADVANCED HEALTH MANAGEMENT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-251-1822
Mailing Address - Street 1:PO BOX 957175
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9520
Mailing Address - Country:US
Mailing Address - Phone:770-734-9036
Mailing Address - Fax:770-252-8226
Practice Address - Street 1:#B7
Practice Address - Street 2:2180 PLEASANT HILL ROAD
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-734-9036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty