Organization Name: | CATALYST PHYSICAL MEDICINE LLC |
NPI Number: | 1396080925 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER L DORGAN (PRESIDENT) |
Mailing Address: | 4914 Atlanta Hwy Alpharetta |
State: | GA US |
Postal Code: | 300042921 |
Phone Number: | 7708337907 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2012 |
NPI Last Update Date: | 12/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 64776 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |