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General NPI Number Information
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NPI Number | 1548313752
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Entity Type | Organization
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Legal Business Name | SOUTHERN WELLNESS & REHAB
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | #2 ED-MOORE
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-764-9951
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Fax | 912-489-4808
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Provider Business Mailing Address
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Address Line | P.O. BOX 961
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City | STATESBORO
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State | GA
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Zip | 30461
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Country | US
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Telephone | 912-764-9951
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Fax | 912-489-4808
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. ARLENE N SMITH
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Credential |
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Telephone | 912-764-9951
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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 | PT006880
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License Number State | GA
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