Provider Demographics
NPI:1861408239
Name:ELITE SPORTS MEDICINE
Entity type:Organization
Organization Name:ELITE SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT ATC
Authorized Official - Phone:770-271-1488
Mailing Address - Street 1:2085 HAMILTON CREEK PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019
Mailing Address - Country:US
Mailing Address - Phone:770-271-1488
Mailing Address - Fax:770-271-1822
Practice Address - Street 1:2085 HAMILTON CREEK PKWY
Practice Address - Street 2:STE 160
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019
Practice Address - Country:US
Practice Address - Phone:770-271-1488
Practice Address - Fax:770-271-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7758698OtherAETNA
GA5620519OtherFIRST HEALTH
GA692612OtherUNITED HEALTHCARE
GA65BBCZZMedicare ID - Type Unspecified
GA7758698OtherAETNA