Provider Demographics
NPI:1740530195
Name:PROHEALTH SPINAL AND REHAB CENTER
Entity type:Organization
Organization Name:PROHEALTH SPINAL AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-876-6972
Mailing Address - Street 1:1860 ATKINSON RD STE 116
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5066
Mailing Address - Country:US
Mailing Address - Phone:770-876-6972
Mailing Address - Fax:770-452-2844
Practice Address - Street 1:1860 ATKINSON RD STE 116
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5066
Practice Address - Country:US
Practice Address - Phone:770-876-6972
Practice Address - Fax:770-452-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007116261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center