Organization
ELITE HEALTHCARE PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN C WEBER (OWNER)
(770) 214-9146
Entity
Organization
Contact information
Practice address
307 ADAMSON SQ, CARROLLTON, GA 30117-3213
(770) 214-9146
(770) 214-9166
Mailing address
307 ADAMSON SQ, CARROLLTON, GA 30117-3213
(770) 214-9146
(770) 214-9166
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
CHIR007565
GA
208D00000X
General Practice Physician
Primary
052922
GA
363LF0000X
Family Nurse Practitioner
RN148627
GA
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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