MEDICARE: REM GEORGIA I LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1588248967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM GEORGIA I LLC

Provider Business Mailing Address
First Line	:	2302 PARKLAKE DR NE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2907
Country	:	US
Telephone Number	:	470-362-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 PARKLAKE DR NE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2907
Country	:	US
Telephone Number	:	470-362-7215
Fax Number	:

Authorized Official
Title or Position	:	STATE DIRECTOR
Name	:	JOE TREBBE
Credential	:
Telephone Number	:	470-362-7215

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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