Organization
PREMIER WELLNESS SOLUTIONS, LLC
Active
Other names
The Atlanta Back Clinic and Orthopedic Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW UNDERWOOD DPT (OWNER AND CLINIC DIRECTOR)
(404) 735-0857
Entity
Organization
Contact information
Practice address
1841 MONTREAL RD STE 110, TUCKER, GA 30084-5713
(404) 735-0857
Mailing address
2716 BROOK PARK WAY, DORAVILLE, GA 30340-1810
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104014125
NPI
—
01
—
1366630345
NPI
—
01
—
1740478734
NPI
—
Enumeration date
11/21/2019
Last updated
11/21/2019
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