Provider Demographics
NPI:1972964641
Name:ATLANTA MOBILE PULMONARY REHAB INC.
Entity Type:Organization
Organization Name:ATLANTA MOBILE PULMONARY REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:404-491-5042
Mailing Address - Street 1:30316 LINKS DR
Mailing Address - Street 2:30316
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-3232
Mailing Address - Country:US
Mailing Address - Phone:404-491-5042
Mailing Address - Fax:470-428-4971
Practice Address - Street 1:30316 LINKS DR.
Practice Address - Street 2:30316
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3232
Practice Address - Country:US
Practice Address - Phone:404-491-5042
Practice Address - Fax:470-428-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicaid