Provider Demographics
NPI:1013042712
Name:SOUTH ATLANT MEDICAL& REHABILITATION, L.L.C.
Entity Type:Organization
Organization Name:SOUTH ATLANT MEDICAL& REHABILITATION, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BRUNET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-817-4053
Mailing Address - Street 1:1711 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4115
Mailing Address - Country:US
Mailing Address - Phone:404-767-7474
Mailing Address - Fax:404-767-7707
Practice Address - Street 1:1711 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4115
Practice Address - Country:US
Practice Address - Phone:404-767-7474
Practice Address - Fax:404-767-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty