Provider Demographics
NPI:1679777932
Name:DREAM MEDICAL & REHAB, LLC
Entity type:Organization
Organization Name:DREAM MEDICAL & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:770-955-3501
Mailing Address - Street 1:2024 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE #110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5011
Mailing Address - Country:US
Mailing Address - Phone:770-955-3501
Mailing Address - Fax:770-955-3505
Practice Address - Street 1:2024 POWERS FERRY RD SE
Practice Address - Street 2:SUITE #110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5011
Practice Address - Country:US
Practice Address - Phone:770-955-3501
Practice Address - Fax:770-955-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121406302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization