| Professional Medical & Rehab Clinic | |
|
2636 Martin Luther King Jr Dr Sw Ste. 12 Atlanta GA 30311-1634 | |
| (404) 748-4952 | |
| (404) 696-2823 |
| Full Name | Professional Medical & Rehab Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2636 Martin Luther King Jr Dr Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Michael Lee (MEMBER) |
| Authorized Official Contact | 4047484952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Medical & Rehab Clinic 2636 Martin Luther King Jr Dr Sw Ste. 12 Atlanta GA 30311-1634 Ph: (404) 748-4952 | Professional Medical & Rehab Clinic 2636 Martin Luther King Jr Dr Sw Ste. 12 Atlanta GA 30311-1634 Ph: (404) 748-4952 |
| NPI Number | 1669716718 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 11/15/2012 |
| Medicare PECOS PAC ID | 2769628890 |
|---|---|
| Medicare Enrollment ID | O20130416000575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669716718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Yolonda A Jefferson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558530188 PECOS PAC ID: 6103714779 Enrollment ID: I20040305000626 |
| Provider Name | Ademola A Opanuga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255584355 PECOS PAC ID: 4183896699 Enrollment ID: I20111005000514 |
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