# ELITE HEALTHCARE PHYSICAL MEDICINE

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

## Provider details

- **NPI number:** 1669736120
- **Authorized official:** DR. RYAN C WEBER (OWNER)
- **Authorized official phone:** (770) 214-9146

## Contact information

- **Practice address:** 307 ADAMSON SQ, CARROLLTON, GA 30117-3213
- **Practice address phone:** (770) 214-9146
- **Practice address fax:** (770) 214-9166
- **Mailing address:** 307 ADAMSON SQ, CARROLLTON, GA 30117-3213
- **Mailing address phone:** (770) 214-9146
- **Mailing address fax:** (770) 214-9166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | CHIR007565 | GA | — |
| 208D00000X | General Practice Physician | 052922 | GA | Yes |
| 363LF0000X | Family Nurse Practitioner | RN148627 | GA | — |

## Other

- **Enumeration date:** 06/29/2012
- **Last updated:** 06/29/2012