Provider Demographics
NPI:1811253487
Name:PHYSICAL MEDICINE CENTERS OF AMERICA LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE CENTERS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYFUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-894-4950
Mailing Address - Street 1:25 FOOTHILLS PKWY
Mailing Address - Street 2:103
Mailing Address - City:MARBLE HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30148-2261
Mailing Address - Country:US
Mailing Address - Phone:770-894-4950
Mailing Address - Fax:770-894-4951
Practice Address - Street 1:25 FOOTHILLS PKWY
Practice Address - Street 2:103
Practice Address - City:MARBLE HILL
Practice Address - State:GA
Practice Address - Zip Code:30148-2261
Practice Address - Country:US
Practice Address - Phone:770-894-4950
Practice Address - Fax:770-894-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty