NPIMap

Organization Active NPI

Genesis Sports Medicine and Rehabilitation, LLC

  • Physical Therapy Clinic/Center
  • Atlanta, GA
National Provider Identifier
1861600520
Registry record updated Jul 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT006133 Issued in GA
Legal business name
GENESIS SPORTS MEDICINE AND REHABILITATION, LLC
Practice address
3890 Redwine Rd SW
Atlanta, GA 30331-5582
Phone
(404) 344-7880
Fax
(404) 344-7881
NPI assigned
May 18, 2007
Last updated
Jul 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2010

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

Authorized official

Name
Mr. Kurt Anthony McDonald, PT , CSCSNPI 1538299474
Title
President
Phone
(404) 290-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT006133 GA Primary

Addresses

Primary practice location

3890 Redwine Rd SW
Atlanta, GA 30331-5582

Mailing address

3890 Redwine Rd SW
Suite 114
Atlanta, GA 30331-5582
Phone (404) 344-7880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080604000404 GA Part B Supplier - Clinic/Group Practice 1759469224 Receives reassigned benefits from 5 practitioners
Practice locations: Atlanta, GA; Smyrna, GA

National Provider Directory

National Provider Directory

Locations

3355 Cascade Rd SW
Ste 102
Atlanta, GA 30311
Phone (404) 505-9030

3890 Redwine Rd SW
Ste 114
Atlanta, GA 30331
Phone (404) 344-7880

4485 S Cobb Dr SE
Ste 200
Smyrna, GA 30080
Phone (770) 989-1057

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279756800000",
    "number": "1861600520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3890 REDWINE RD SW",
            "address_2": "SUITE 114",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315582",
            "telephone_number": "404-344-7880",
            "fax_number": "404-344-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3890 REDWINE RD SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315582",
            "telephone_number": "404-344-7880",
            "fax_number": "404-344-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS SPORTS MEDICINE AND REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2010-07-22",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-290-1700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT , CSCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT006133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.