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General NPI Number Information
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NPI Number | 1366844367
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA FAMILY REHAB
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 100 HAMILTON POINTE DR. SUITE 115 & 120
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City | BYRON
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State | GA
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Zip | 31008
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Country | US
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Telephone | 478-956-4916
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Fax | 478-956-0958
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Provider Business Mailing Address
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Address Line | 100 HAMILTON POINTE DR P.O. BOX 1552
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City | BYRON
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State | GA
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Zip | 31008
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Country | US
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Telephone | 478-956-4916
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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 | BRENDA HICKS
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Credential |
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Telephone | 478-956-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | PT002436
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License Number State | GA
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