MEDICARE: PHOENIX WELLNESS AND REHABIILITATION SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
2	251E00000X	Home Health Agency
3	261QH0100X	Health Service Clinic/Center
4	261QI0500X	Infusion Therapy Clinic/Center
5	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1265235733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX WELLNESS AND REHABIILITATION SERVICES

Provider Business Mailing Address
First Line	:	2959 HERRON LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1501
Country	:	US
Telephone Number	:	678-591-3873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 HERRON LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1501
Country	:	US
Telephone Number	:	678-591-3873
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LATRISHA MCCAULEY
Credential	:	DC
Telephone Number	:	678-591-3873

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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