Provider Demographics
NPI:1902170038
Name:VENTURE HEALTHCARE
Entity Type:Organization
Organization Name:VENTURE HEALTHCARE
Other - Org Name:VENTURE PHYSICAL THERAPY STOCKBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-474-9514
Mailing Address - Street 1:125 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5083
Mailing Address - Country:US
Mailing Address - Phone:770-474-9514
Mailing Address - Fax:770-389-5602
Practice Address - Street 1:125 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5083
Practice Address - Country:US
Practice Address - Phone:770-474-9514
Practice Address - Fax:770-389-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty