MEDICARE: CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	113146	GA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1013955194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	303 PERIMETER CTR N
Second Line	:	SUITE 510
City	:	ATLANTA
State	:	GA
Zip	:	30346-3402
Country	:	US
Telephone Number	:	770-379-1035
Fax Number	:	770-234-5172

Provider Business Practice Location Address
First Line	:	303 PERIMETER CTR N
Second Line	:	SUITE 510
City	:	ATLANTA
State	:	GA
Zip	:	30346-3402
Country	:	US
Telephone Number	:	770-379-1035
Fax Number	:	770-234-5172

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. NANCY NURNBERG
Credential	:
Telephone Number	:	770-379-1035

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/25/2010

303 PERIMETER CTR N
ATLANTA, GA
30346-3402

Practice Phone: 770-264-1920
Practice Fax: