# EXECUTIVE MEDICAL PRACTICE L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265136923
- **Authorized official:** RASHELLE FOX (CREDITIALING)
- **Authorized official phone:** (404) 664-2997

## Contact information

- **Practice address:** 1455 BELLS FERRY RD STE 100, MARIETTA, GA 30066-6078
- **Practice address phone:** (770) 421-8094
- **Practice address fax:** (770) 421-8096
- **Mailing address:** 1455 BELLS FERRY RD STE 100, MARIETTA, GA 30066-6078
- **Mailing address phone:** (770) 421-8094
- **Mailing address fax:** (770) 421-8096

## Taxonomy

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

## Other

- **Enumeration date:** 03/28/2023
- **Last updated:** 08/21/2023