Provider Demographics
NPI:1346547932
Name:SUGARLOAF SPINE & REHAB INC
Entity type:Organization
Organization Name:SUGARLOAF SPINE & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-817-4445
Mailing Address - Street 1:1180 MCKENDREE CHURCH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5207
Mailing Address - Country:US
Mailing Address - Phone:770-817-4445
Mailing Address - Fax:770-962-3474
Practice Address - Street 1:1180 MCKENDREE CHURCH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5207
Practice Address - Country:US
Practice Address - Phone:770-817-4445
Practice Address - Fax:770-817-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty