Provider Demographics
NPI:1720100126
Name:ATLANTA INTERNATIONAL PT, INC
Entity Type:Organization
Organization Name:ATLANTA INTERNATIONAL PT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:O
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-622-2532
Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD
Mailing Address - Street 2:BLDG G.
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3035
Mailing Address - Country:US
Mailing Address - Phone:770-622-2532
Mailing Address - Fax:770-622-2534
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:BLDG G.
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:770-622-2532
Practice Address - Fax:770-622-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03810225100000X
GAOT003725225X00000X
GAOT002773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00811148EMedicaid