Healthcare Provider Details

I. General information

NPI: 1285551499
Provider Name (Legal Business Name): SOUTH GEORGIA PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S PARRISH AVE
ADEL GA
31620-3595
US

IV. Provider business mailing address

606 S PARRISH AVE
ADEL GA
31620-3595
US

V. Phone/Fax

Practice location:
  • Phone: 229-873-5699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAYLA STONE
Title or Position: OWNER/PROVIDER
Credential: OTR/L
Phone: 229-873-5699