Healthcare Provider Details

I. General information

NPI: 1821008087
Provider Name (Legal Business Name): NORTHEAST GEORGIA REHABILITATION CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COOK ST
ROYSTON GA
30662-3905
US

IV. Provider business mailing address

651 COOK ST
ROYSTON GA
30662-3905
US

V. Phone/Fax

Practice location:
  • Phone: 706-246-0542
  • Fax: 706-246-0543
Mailing address:
  • Phone: 706-246-0542
  • Fax: 706-246-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM L BEADLES
Title or Position: COOWNER
Credential: PT
Phone: 706-246-0542