Provider Demographics
NPI:1154408615
Name:PRIMACARE REHABILITATION P.C.
Entity type:Organization
Organization Name:PRIMACARE REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, MBA
Authorized Official - Phone:770-962-4043
Mailing Address - Street 1:2020 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2663
Mailing Address - Country:US
Mailing Address - Phone:770-962-4043
Mailing Address - Fax:770-962-4045
Practice Address - Street 1:2020 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:STE 102
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2663
Practice Address - Country:US
Practice Address - Phone:770-962-4043
Practice Address - Fax:770-962-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003387261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5027Medicare ID - Type Unspecified