# ACTIVE LIFE HEALTH OF MARIETTA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ARTHRITIS KNEE PAIN CENTERS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174292411
- **Authorized official:** JOHN J RUSH MD (CHAIRMAN & CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (770) 728-8446

## Contact information

- **Practice address:** 540 POWDER SPRINGS ST STE 29, MARIETTA, GA 30064-3549
- **Practice address phone:** (770) 728-8446
- **Practice address fax:** (770) 370-8172
- **Mailing address:** 540 POWDER SPRINGS ST STE 29, MARIETTA, GA 30064-3549
- **Mailing address phone:** (770) 728-8446
- **Mailing address fax:** (770) 370-8172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2021
- **Last updated:** 12/13/2021