MEDICARE: ABILITY REHAB, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	OPPT000791	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	202G709590	OTHER	GA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	704857	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1104138361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABILITY REHAB, LLC

Provider Business Mailing Address
First Line	:	1835 SAVOY DR.
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30341-1072
Country	:	US
Telephone Number	:	678-298-9484
Fax Number	:	678-826-4033

Provider Business Practice Location Address
First Line	:	1835 SAVOY DR.
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30341-1072
Country	:	US
Telephone Number	:	678-298-9484
Fax Number	:	678-826-4033

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PRASANT H DESAI
Credential	:	MBA, MPH
Telephone Number	:	678-298-9484

Provider Enumeration Date	:	07/04/2010
Last Update Date	:	03/08/2013

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Directions to “ABILITY REHAB, LLC ” Practice Location

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