Provider Demographics
NPI:1104224641
Name:ATLANTA REHABILITATION PHYSICIANS, P.C.
Entity type:Organization
Organization Name:ATLANTA REHABILITATION PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-402-1845
Mailing Address - Street 1:1245 LEGEND RUN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2282
Mailing Address - Country:US
Mailing Address - Phone:770-402-1845
Mailing Address - Fax:
Practice Address - Street 1:11775 POINTE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4655
Practice Address - Country:US
Practice Address - Phone:770-619-0010
Practice Address - Fax:770-664-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty