MEDICARE: NORTHEAST GEORGIA REHABILITATION CENTER,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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1821008087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST GEORGIA REHABILITATION CENTER,INC

Provider Business Mailing Address
First Line	:	651 COOK ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3905
Country	:	US
Telephone Number	:	706-246-0542
Fax Number	:	706-246-0543

Provider Business Practice Location Address
First Line	:	651 COOK ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3905
Country	:	US
Telephone Number	:	706-246-0542
Fax Number	:	706-246-0543

Authorized Official
Title or Position	:	COOWNER
Name	:	ADAM L BEADLES
Credential	:	PT
Telephone Number	:	706-246-0542

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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