Provider Demographics
NPI:1528144870
Name:CONCORD ACCIDENT & INJURY LLC
Entity type:Organization
Organization Name:CONCORD ACCIDENT & INJURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-468-5543
Mailing Address - Street 1:PO BOX 550029
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-2529
Mailing Address - Country:US
Mailing Address - Phone:404-468-5543
Mailing Address - Fax:
Practice Address - Street 1:1105 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4207
Practice Address - Country:US
Practice Address - Phone:770-432-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty