Healthcare Provider Details

I. General information

NPI: 1982620183
Provider Name (Legal Business Name): THERAPEUTIC INTERVENTIONS OF GEORGIA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 CENTRAL AVE STE C
AUGUSTA GA
30904-6246
US

IV. Provider business mailing address

2315 CENTRAL AVE STE C
AUGUSTA GA
30904-6246
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-6172
  • Fax:
Mailing address:
  • Phone: 706-364-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025171
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number025171
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025171
License Number StateGA

VIII. Authorized Official

Name: JENNIFER STEPHENS
Title or Position: OWNER/SPEECH-LANGUAGE PATHOLOGIST
Credential: PHD-CCC-SLP
Phone: 706-364-6172