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General NPI Number Information
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NPI Number | 1225257132
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA PHYSICAL MEDICINE AND REHABILITATION
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6677
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Country | US
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Telephone | 229-226-9412
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1053
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City | THOMASVILLE
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State | GA
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Zip | 31799-1053
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Country | US
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Telephone | 229-226-9412
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LEAH M SAUNDERS
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Credential |
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Telephone | 229-226-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 041159
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License Number State | GA
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