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NPI Code Detail

MEDICARE: MCKENNA FARMS THERAPY SERVICES INC

MEDICARE: MCKENNA FARMS THERAPY SERVICES INC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1417904947
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCKENNA FARMS THERAPY SERVICES INC
Provider Business Mailing Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Provider Business Practice Location Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Authorized Official
Title or Position : BILLING SPECIALIST
Name : CHERYL ZIEGLER
Credential :
Telephone Number : 770-432-8996
Provider Enumeration Date : 05/29/2006
Last Update Date : 08/22/2020

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