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General NPI Number Information
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NPI Number | 1528240348
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Entity Type | Organization
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Legal Business Name | GEORGIA REHABILITATION SPECIALISTS, LLC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 1438 HIGHWAY 16 W SUITE C
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City | GRIFFIN
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State | GA
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Zip | 30223-2054
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Country | US
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Telephone | 770-467-4426
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Fax | 770-467-4427
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Provider Business Mailing Address
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Address Line | PO BOX 2331
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City | GRIFFIN
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State | GA
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Zip | 30224-0059
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Country | US
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Telephone | 770-467-4426
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Fax | 770-467-4427
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. MICHAEL A VAUGHN
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Credential |
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Telephone | 770-467-4426
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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 | PT007305
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License Number State | GA
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