Provider Demographics
NPI:1447775242
Name:ELITE SPORT & PERSONAL INJURY CENTERS OF ATLANTA LLC
Entity type:Organization
Organization Name:ELITE SPORT & PERSONAL INJURY CENTERS OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-606-9833
Mailing Address - Street 1:67 PEACHTREE PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1370
Mailing Address - Country:US
Mailing Address - Phone:678-606-9833
Mailing Address - Fax:
Practice Address - Street 1:67 PEACHTREE PARK DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1370
Practice Address - Country:US
Practice Address - Phone:678-606-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty