Provider Demographics
NPI:1902288541
Name:ATLANTA HEALTH AND INJURY CLINIC INC.
Entity Type:Organization
Organization Name:ATLANTA HEALTH AND INJURY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ORIE
Authorized Official - Middle Name:TRAVOY
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:404-229-6222
Mailing Address - Street 1:550 FAIRBURN RD SW STE A5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2015
Mailing Address - Country:US
Mailing Address - Phone:404-691-4822
Mailing Address - Fax:404-692-4144
Practice Address - Street 1:550 FAIRBURN RD SW STE A5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2015
Practice Address - Country:US
Practice Address - Phone:404-691-4822
Practice Address - Fax:404-692-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G70757Medicare UPIN