Provider Demographics
NPI:1922379304
Name:THE INJURY WELLNESS SURGICAL AND PROCEDURE INSTITUTE LLC
Entity Type:Organization
Organization Name:THE INJURY WELLNESS SURGICAL AND PROCEDURE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-439-7575
Mailing Address - Street 1:2483 POWDER SPRINGS RD SW
Mailing Address - Street 2:STE C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4573
Mailing Address - Country:US
Mailing Address - Phone:770-439-7575
Mailing Address - Fax:770-439-7550
Practice Address - Street 1:2483 POWDER SPRINGS RD SW
Practice Address - Street 2:STE C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4573
Practice Address - Country:US
Practice Address - Phone:770-439-7575
Practice Address - Fax:770-439-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty