Provider Demographics
NPI:1528240348
Name:GEORGIA REHABILITATION SPECIALISTS, LLC
Entity type:Organization
Organization Name:GEORGIA REHABILITATION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-467-4426
Mailing Address - Street 1:PO BOX 2331
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0059
Mailing Address - Country:US
Mailing Address - Phone:770-467-4426
Mailing Address - Fax:770-467-4427
Practice Address - Street 1:1438 HIGHWAY 16 W
Practice Address - Street 2:SUITE C
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2054
Practice Address - Country:US
Practice Address - Phone:770-467-4426
Practice Address - Fax:770-467-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty