Healthcare Provider Details

I. General information

NPI: 1306172655
Provider Name (Legal Business Name): WORKSAFE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 SYDNEYS PASS
WATKINSVILLE GA
30677-8393
US

IV. Provider business mailing address

1367 SYDNEYS PASS
WATKINSVILLE GA
30677-8393
US

V. Phone/Fax

Practice location:
  • Phone: 770-725-9186
  • Fax: 603-843-2144
Mailing address:
  • Phone: 770-725-9186
  • Fax: 603-843-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006029
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT002264
License Number StateGA

VIII. Authorized Official

Name: MR. HULET SMITH JR.
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 770-725-9186