1609963115 NPI number — GEORGIA SOUTH HAND THERAPY, INC

Table of content: (NPI 1609963115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609963115 NPI number — GEORGIA SOUTH HAND THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA SOUTH HAND THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609963115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7444 HANNOVER PKWY S
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-9303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-474-4595
Provider Business Mailing Address Fax Number:
770-474-4182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7444 HANNOVER PKWY S
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-9303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-474-4595
Provider Business Practice Location Address Fax Number:
770-474-4182
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
LUCY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE/BILLING MANAGER
Authorized Official Telephone Number:
770-474-4595

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: #P-11215765 . This is a "MULTI PLAN HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 670002188 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 253024492A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612611600 . This is a "DEPT OF LABOR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7921605 . This is a "AETNA HEALTH INS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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