Healthcare Provider Details

I. General information

NPI: 1356406466
Provider Name (Legal Business Name): SOUTHWEST GEORGIA THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W FRANKLIN ST
SYLVESTER GA
31791-7174
US

IV. Provider business mailing address

PO BOX 846
SYLVESTER GA
31791-0846
US

V. Phone/Fax

Practice location:
  • Phone: 229-821-3892
  • Fax: 229-821-3893
Mailing address:
  • Phone: 229-821-3892
  • Fax: 229-821-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2447
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM JENKINS JR.
Title or Position: PRESIDENT
Credential: PT
Phone: 229-821-3892