Provider Demographics
NPI:1649646779
Name:PERSONAL INJURY MD LLC
Entity type:Organization
Organization Name:PERSONAL INJURY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-769-2346
Mailing Address - Street 1:2483 POWDER SPRINGS RD SW
Mailing Address - Street 2:STE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4573
Mailing Address - Country:US
Mailing Address - Phone:770-769-2346
Mailing Address - Fax:678-903-6951
Practice Address - Street 1:2483 POWDER SPRINGS RD SW
Practice Address - Street 2:STE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4573
Practice Address - Country:US
Practice Address - Phone:770-769-2346
Practice Address - Fax:678-903-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty