Provider Demographics
NPI:1669690723
Name:INJURY CENTERS OF ATLANTA L.L.C
Entity type:Organization
Organization Name:INJURY CENTERS OF ATLANTA L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-638-6060
Mailing Address - Street 1:2566 SHALLOWFORD RD NE STE 104-308
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1202
Mailing Address - Country:US
Mailing Address - Phone:404-638-6060
Mailing Address - Fax:
Practice Address - Street 1:4186 BUFORD HWY NE STE F
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1067
Practice Address - Country:US
Practice Address - Phone:404-638-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038164-19942081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty