Provider Demographics
NPI:1063945947
Name:INJURY AND REHAB CENTERS OF GEORGIA, LLC
Entity type:Organization
Organization Name:INJURY AND REHAB CENTERS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA-IZAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-696-2404
Mailing Address - Street 1:1568 INDIAN TRAIL LILBURN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2613
Mailing Address - Country:US
Mailing Address - Phone:770-696-2404
Mailing Address - Fax:770-696-2135
Practice Address - Street 1:1568 INDIAN TRAIL LILBURN RD STE 105
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2613
Practice Address - Country:US
Practice Address - Phone:770-696-2404
Practice Address - Fax:770-696-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty