Provider Demographics
NPI:1124487749
Name:PATHWAY OUTPATIENT SERVICES, LLC
Entity type:Organization
Organization Name:PATHWAY OUTPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:BREMNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-639-7100
Mailing Address - Street 1:227 SANDY SPRINGS PL
Mailing Address - Street 2:SUITE D # 298
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5918
Mailing Address - Country:US
Mailing Address - Phone:770-639-0558
Mailing Address - Fax:
Practice Address - Street 1:241 LEMON ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1644
Practice Address - Country:US
Practice Address - Phone:770-639-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)