Provider Demographics
NPI:1083144109
Name:SOUTHERN HEALTH CORP OF ELLIJAY
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CORP OF ELLIJAY
Other - Org Name:PARKSIDE ELLIJAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-635-7881
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0025
Mailing Address - Country:US
Mailing Address - Phone:706-635-7881
Mailing Address - Fax:706-276-3698
Practice Address - Street 1:1362 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5410
Practice Address - Country:US
Practice Address - Phone:706-635-7881
Practice Address - Fax:706-276-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)