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General NPI Number Information
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NPI Number | 1821796145
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE AND REHAB THERAPY CAMDEN
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 1891 HWY 40 E STE 1104
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City | KINGSLAND
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State | GA
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Zip | 31548-6573
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Country | US
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Telephone | 912-522-8404
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Fax | 912-522-8406
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Provider Business Mailing Address
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Address Line | 1891 HWY 40 E STE 1104
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City | KINGSLAND
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State | GA
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Zip | 31548-6573
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Country | US
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Telephone | 912-522-8404
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Fax | 912-522-8406
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. CLAYTON CONNERS
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Credential | PT, DPT, OCS
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Telephone | 912-522-8404
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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 |
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License Number State |
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