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General NPI Number Information
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NPI Number | 1356406466
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Entity Type | Organization
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Legal Business Name | SOUTHWEST GEORGIA THERAPY, INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 1009 W FRANKLIN ST
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City | SYLVESTER
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State | GA
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Zip | 31791-7174
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Country | US
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Telephone | 229-821-3892
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Fax | 229-821-3893
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | SYLVESTER
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State | GA
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Zip | 31791-0846
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Country | US
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Telephone | 229-821-3892
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Fax | 229-821-3893
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM JENKINS JR.
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Credential | PT
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Telephone | 229-821-3892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2447
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License Number State | GA
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