NPIMap

Organization Active NPI

Pro Health and Rehab LLC

  • Rehabilitation Chiropractor
  • Marietta, GA
National Provider Identifier
1982887543
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
CHIR006384 Issued in GA
Legal business name
PRO HEALTH AND REHAB LLC
Practice address
2453 Powder Springs Rd SW
Suite 215
Marietta, GA 30064-4570
Phone
(678) 567-2313
Fax
(855) 771-9101
NPI assigned
Dec 6, 2007
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Stefan Charles G Saboura, DCNPI 1649349952
Title
Owner/ Provider
Phone
(678) 567-2313

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN191854 GA
Family Medicine Physician 207Q00000X 39009 GA
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X 68404 GA
Rehabilitation Chiropractor 111NR0400X CHIR006384 GA Primary

Addresses

Primary practice location

2453 Powder Springs Rd SW
Suite 215
Marietta, GA 30064-4570

Mailing address

2453 Powder Springs Rd SW
Suite 215
Marietta, GA 30064-4570
Phone (678) 567-2313

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120813000837 GA Part B Supplier - Clinic/Group Practice 5496901019 Receives reassigned benefits from 5 practitioners
Practice locations: Marietta, GA

National Provider Directory

National Provider Directory

Locations

2453 Powder Springs Rd SW
Ste 210
Marietta, GA 30064
Phone (678) 567-2313

Interoperability endpoints

  • Direct secure messaging: phrl0001@phrl0001.direct.chirotouch.md

Practitioners & affiliated clinicians

Practitioners 9

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": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1982887543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2453 POWDER SPRINGS RD SW",
            "address_2": "SUITE 215",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300644570",
            "telephone_number": "678-567-2313",
            "fax_number": "855-771-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2453 POWDER SPRINGS RD SW",
            "address_2": "SUITE 215",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300644570",
            "telephone_number": "678-567-2313",
            "fax_number": "855-771-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO HEALTH AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "SABOURA",
        "authorized_official_first_name": "STEFAN CHARLES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/ PROVIDER",
        "authorized_official_telephone_number": "678-567-2313",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN191854",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "39009",
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "GA",
            "license": "68404",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR006384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.