GENESIS SPORTS MEDICINE AND REHABILITATION, LLC (NPI# 1861600520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861600520 |
| Entity Type | Organization |
| Organization Name | GENESIS SPORTS MEDICINE AND REHABILITATION, LLC |
| Practice Address |
3890 Redwine Rd Sw Atlanta GA 30331-5582 |
| Mailing Address |
3890 Redwine Rd Sw Suite 114 Atlanta GA 30331-5582 |
| Practice Telephone | 4043447880 |
| Practice Fax Number | 4043447881 |
| Mailing Telephone | 4043447880 |
| Mailing Fax Number | 4043447881 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-07-22 |
| Authorized Official Name | MR. KURT ANTHONY MCDONALD (PRESIDENT) |
| Authorized Official Telephone | 4042901700 |
| Authorized Official Credential | PT , CSCS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
PT006133 | GA | Ambulatory Health Care Facilities |
| Street Address |
3890 REDWINE RD SW |
| City | ATLANTA |
| State | GA |
| Zip Code | 30331-5582 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588659908 | Dara Paul | Specialist | 3890 Redwine Rd Sw, Ste 210, Atlanta, GA 30331-5509 | 2005-09-12 |
| 1538616305 | Marion Bianca Tyson | Physical Therapist | 3890 Redwine Rd Sw, Suite 114, Atlanta, GA 30331-5582 | 2016-09-08 |
| 1871853606 | Paddyson Chukwuka Chidi | Physical Therapist | 3890 Redwine Rd Sw, Suite 114, Atlanta, GA 30331-5582 | 2012-05-27 |
| 1447529342 | Pain Management of The South | Anesthesiology | 3890 Redwine Rd Sw, Suite 200, Atlanta, GA 30331-5582 | 2011-12-21 |
| 1487957924 | Pinnacle Diagnostic and Dme Services, LLC | Durable Medical Equipment & Medical Supplies | 3890 Redwine Rd Sw, Suite 200, Atlanta, GA 30331-5582 | 2010-12-06 |
| 1598072910 | Willis C Jenkins | Physical Therapy Assistant | 3890 Redwine Rd Sw, Suite 114, Atlanta, GA 30331-5582 | 2010-09-07 |
| 1184939456 | Accident Centers of Atlanta, LLC | Durable Medical Equipment & Medical Supplies | 3890 Redwine Rd Sw, Suite 200, Atlanta, GA 30331-5582 | 2010-08-11 |
| 1770811713 | Camp Creek Smiles Family Dentistry | Clinic/Center | 3890 Redwine Rd Sw, Ste 108, Atlanta, GA 30331-5582 | 2009-12-03 |
| 1922269612 | Camp Creek Pediatrics LLC | Clinic/Center | 3890 Redwine Rd Sw, Suite 100, Atlanta, GA 30331-5582 | 2008-06-24 |
| 1700072485 | Premier Eye Physicians PC | Clinic/Center | 3890 Redwine Rd Sw, Suite 212, Atlanta, GA 30331-5582 | 2007-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861001174 | Whitney Flemister | Social Worker | 3961 Princeton Lakes Way Sw, Atlanta, GA 30331 | 2020-07-23 |
| 1982237400 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 5829 Campbellton Road, S.w, Suite 110, Atlanta, GA 30331 | 2020-02-13 |
| 1295375558 | Drusilla Precious Cudjoe | Behavior Technician | 3800 Camp Creek Parkway Sw, Building 1400, Atlanta, GA 30331 | 2020-01-14 |
| 1497262778 | Champions Pharmacy | Pharmacy | 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 | 2018-01-08 |
| 1033629779 | Carmen Ardoin | Counselor | 2636 Martin Luther King Jr. Drive, Suite 12, Atlanta, GA 30331 | 2017-10-09 |
| 1346759974 | Neva R Allison | Nurse Practitioner | 2611 Dayview Ln, Atlanta, GA 30331 | 2017-09-26 |
| 1538678255 | Natalie Mckay | Technician/Technologist | 3915 Cascade Rd, 220, Atlanta, GA 30331 | 2017-09-26 |
| 1700304268 | Tyrone Pipkin | Contractor | 415 Kendrick Terrace Sw, Atlanta, GA 30331 | 2017-09-05 |
| 1073031688 | Kristen Wooldridge | Pharmacist | 3695 Cascade Road, Atlanta, GA 30331 | 2017-09-04 |
| 1548704687 | Advance Pain Management | Health Maintenance Organization | 2950 Stone Hogan Road Connector, Atlanta, GA 30331 | 2016-12-08 |
| Find all providers in zip 30331 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205441987 | Fortitude Movement & Strength Inc. | Clinic/Center | 5300 Peachtree Rd Unit 2508, Atlanta, GA 30341-2457 | 2020-09-10 |
| 1225646821 | Innovative Therapeutic Solutions, LLC | Clinic/Center | 360 Pharr Rd Ne Apt 404, Atlanta, GA 30305-2391 | 2020-07-20 |
| 1700355690 | Lindsay Hazel Bautista | Clinic/Center | 3380 Peachtree Rd Ne Unit 814, Atlanta, GA 30326-1645 | 2018-11-20 |
| 1891281218 | Well Equipt | Clinic/Center | 2426 Ridgewood Rd Nw, Atlanta, GA 30318-1316 | 2018-07-09 |
| 1811426075 | Assistcare Surgical Aftercare and Physical Therapy | Clinic/Center | 3576 Chamblee Tucker Rd Ste Bc&d, Atlanta, GA 30341-4424 | 2017-06-09 |
| 1871022541 | Aczi, LLC | Clinic/Center | 2800 N Druid Hills Rd Ne Ste C, Atlanta, GA 30329-3987 | 2017-06-07 |
| 1134587074 | Functionize Health & Physical Therapy | Clinic/Center | 1199 Saint Andrews Cir, Atlanta, GA 30338-3201 | 2016-02-07 |
| 1952779043 | Holistic Occupational and Physical Therapy | Clinic/Center | 1393 Blairwood Ct, Atlanta, GA 30331-7491 | 2015-09-08 |
| 1225416100 | Fit Core Physical Therapy, Inc. | Clinic/Center | 4779 S Atlanta Rd Se Ste 200, Atlanta, GA 30339-1565 | 2015-05-12 |
| 1538561659 | Golden Way Group Inc | Clinic/Center | 235 Peachtree Street, Suite 400, Atlanta, GA 30303 | 2014-09-19 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.