Active Care Medical Associates of Forest Park

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

Legal business name

ACTIVE CARE MEDICAL ASSOCIATES OF FOREST PARK

Practice address

1075 Main Street
Forest Park, GA 30297

Phone

(404) 366-4124

Fax

(404) 366-0297

NPI assigned

May 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer Danielle Crawford

Title

Office Manager

Phone

(404) 366-4124

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427265495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#342 5656 JONESBORO ROAD",
            "address_2": "SUITE #111",
            "city": "LAKE CITY",
            "state": "GA",
            "postal_code": "30260",
            "telephone_number": "404-366-4124",
            "fax_number": "404-366-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 MAIN STREET",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "30297",
            "telephone_number": "404-366-4124",
            "fax_number": "404-366-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE CARE MEDICAL ASSOCIATES OF FOREST PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "404-366-4124",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physical Therapist in Forest Park, GA
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• Sports Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.