MEDICARE: SUPERIOR HEALTHCARE 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	208100000X	Physical Medicine & Rehabilitation Physician	PT003630	GA

General Provider Information

NPI Number	:	1295782514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:	770-345-9611

Provider Business Practice Location Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:	770-345-9611

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN D PEYROUX
Credential	:	D.C.
Telephone Number	:	770-345-9600

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/19/2013

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