Basic Information
| Provider Information | |||||||||
| NPI: | 1952078859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTA REHABILITATION AND PERFORMANCE CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 WISTERIA DR STE A | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300782689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709820102 | ||||||||
| FaxNumber: | 7709820130 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 JESSE JEWELL PKWY NE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305012561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705369300 | ||||||||
| FaxNumber: | 7705369389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARCINKOVICH | ||||||||
| AuthorizedOfficialFirstName: | HANNAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 4046300498 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ATLANTA REHABILITATION AND PERFORMANCE CENTER, INC | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.