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General NPI Number Information
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NPI Number | 1972092955
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Entity Type | Organization
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Legal Business Name | GEORGIA GERIATRICS AND REHABILITATION
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Dates
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Enumeration Date | 05/06/2018
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 549 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6347
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Country | US
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Telephone | 404-438-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 549 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIE DAVID BEAVERS III
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Credential | PT, DPT, GCS
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Telephone | 404-438-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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