Provider Demographics
NPI:1972635175
Name:REHAB ATLANTA, INC.
Entity Type:Organization
Organization Name:REHAB ATLANTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:770-442-0836
Mailing Address - Street 1:11685 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 155
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4913
Mailing Address - Country:US
Mailing Address - Phone:770-442-0836
Mailing Address - Fax:770-664-0985
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4913
Practice Address - Country:US
Practice Address - Phone:770-442-0836
Practice Address - Fax:770-664-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026588225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACC9720OtherRAILROAD MEDICARE
GACC9720OtherRAILROAD MEDICARE