Provider Demographics
NPI:1982887543
Name:PRO HEALTH AND REHAB LLC
Entity Type:Organization
Organization Name:PRO HEALTH AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:SABOURA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-567-2313
Mailing Address - Street 1:2453 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4570
Mailing Address - Country:US
Mailing Address - Phone:678-567-2313
Mailing Address - Fax:855-771-9101
Practice Address - Street 1:2453 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4570
Practice Address - Country:US
Practice Address - Phone:678-567-2313
Practice Address - Fax:855-771-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006384111NR0400X
GA39009207Q00000X
GA684042083P0500X
GARN191854363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty