Provider Demographics
NPI:1215610381
Name:PEACHTREE CENTER REHAB MEDICAL SERVICES
Entity type:Organization
Organization Name:PEACHTREE CENTER REHAB MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-522-9991
Mailing Address - Street 1:241 PEACHTREE ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1421
Mailing Address - Country:US
Mailing Address - Phone:404-522-9991
Mailing Address - Fax:404-522-9890
Practice Address - Street 1:241 PEACHTREE ST NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1421
Practice Address - Country:US
Practice Address - Phone:404-522-9991
Practice Address - Fax:404-522-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty