Provider Demographics
NPI:1831422567
Name:PERIMETER SPINE & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:PERIMETER SPINE & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:770-392-9299
Mailing Address - Street 1:7100 PEACHTREE DUNWOODY RD NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1689
Mailing Address - Country:US
Mailing Address - Phone:770-392-9299
Mailing Address - Fax:770-392-9298
Practice Address - Street 1:7100 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1689
Practice Address - Country:US
Practice Address - Phone:770-392-9299
Practice Address - Fax:770-392-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038955332BC3200X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6312530001Medicare NSC