Provider Demographics
NPI:1114981669
Name:SOUTHERN THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BO
Authorized Official - Last Name:HAMIL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:770-832-2484
Mailing Address - Street 1:120 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3303
Mailing Address - Country:US
Mailing Address - Phone:770-832-2484
Mailing Address - Fax:770-830-5961
Practice Address - Street 1:812 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4412
Practice Address - Country:US
Practice Address - Phone:770-834-7436
Practice Address - Fax:770-830-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116684Medicare Oscar/Certification