Provider Demographics
NPI:1952985509
Name:ADVANCE THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:ADVANCE THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING LIASION
Authorized Official - Prefix:
Authorized Official - First Name:REASONS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-552-1049
Mailing Address - Street 1:150 MEDICAL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:404-781-2800
Mailing Address - Fax:833-897-2947
Practice Address - Street 1:2950 STONE HOGAN CONNECTOR RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2837
Practice Address - Country:US
Practice Address - Phone:404-781-2800
Practice Address - Fax:833-897-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation