Provider Demographics
NPI:1891521050
Name:TRISTAR INJURY CENTER OF LITHONIA LLC
Entity type:Organization
Organization Name:TRISTAR INJURY CENTER OF LITHONIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-730-6240
Mailing Address - Street 1:3011 SUTTON GATE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5153
Mailing Address - Country:US
Mailing Address - Phone:678-730-6240
Mailing Address - Fax:678-730-1005
Practice Address - Street 1:5700 HILLANDALE DR STE 190
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4104
Practice Address - Country:US
Practice Address - Phone:678-730-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty