Healthcare Provider Details

I. General information

NPI: 1720614423
Provider Name (Legal Business Name): GEORGIA THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 GA HIGHWAY 18 W
GRAY GA
31032-3734
US

IV. Provider business mailing address

922 GA HIGHWAY 18 W
GRAY GA
31032-3734
US

V. Phone/Fax

Practice location:
  • Phone: 478-986-8527
  • Fax:
Mailing address:
  • Phone: 478-986-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LACY LEE GARDNER-HATTAWAY
Title or Position: PRESIDENT
Credential: OTD, OTR/L, C/NDT
Phone: 478-986-8527