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General NPI Number Information
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NPI Number | 1962968222
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Entity Type | Organization
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Legal Business Name | RECOVERY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 226 S ZETTEROWER AVE
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City | STATESBORO
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State | GA
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Zip | 30458-7135
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Country | US
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Telephone | 912-266-9094
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Fax |
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Provider Business Mailing Address
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Address Line | 226 S ZETTEROWER AVE
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City | STATESBORO
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State | GA
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Zip | 30458-7135
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Country | US
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Telephone | 912-266-9094
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHAEL HALL
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Credential | MD
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Telephone | 912-927-6832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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