Provider Demographics
NPI:1063805091
Name:SOUTHWEST ATLANTA MEDICAL & REHABILITATION CLINIC LLC
Entity type:Organization
Organization Name:SOUTHWEST ATLANTA MEDICAL & REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-705-1733
Mailing Address - Street 1:495 85 CIRCLE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349
Mailing Address - Country:US
Mailing Address - Phone:678-705-1733
Mailing Address - Fax:678-573-5039
Practice Address - Street 1:495 85 CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349
Practice Address - Country:US
Practice Address - Phone:678-705-1733
Practice Address - Fax:678-573-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty