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General NPI Number Information
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NPI Number | 1699868117
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Entity Type | Organization
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Legal Business Name | GEORGIA REHABILITATION OUTREACH
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 1777 WASHINGTON ROAD
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City | EAST POINT
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State | GA
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Zip | 30344
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Country | US
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Telephone | 404-892-0998
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Fax | 404-872-0095
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Provider Business Mailing Address
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Address Line | 1777 WASHINGTON ROAD
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City | EAST POINT
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State | GA
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Zip | 30344
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Country | US
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Telephone | 404-892-0998
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Fax | 404-872-0095
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | BRENDA BELL
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Credential |
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Telephone | 404-892-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1041C0700X
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License Number State | GA
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