Provider Demographics
NPI:1952564155
Name:MERIDIAN HEALTH & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MERIDIAN HEALTH & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-901-9303
Mailing Address - Street 1:1140 HAMMOND DR NE
Mailing Address - Street 2:SUITE G7110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5338
Mailing Address - Country:US
Mailing Address - Phone:770-901-9303
Mailing Address - Fax:770-901-9332
Practice Address - Street 1:1140 HAMMOND DR NE
Practice Address - Street 2:SUITE G7110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-901-9303
Practice Address - Fax:770-901-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054116261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy