Provider Demographics
NPI:1164609921
Name:MCPHERSON HEALTH AND REHABILITATION
Entity Type:Organization
Organization Name:MCPHERSON HEALTH AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MCPHERSON
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EDD
Authorized Official - Phone:678-842-0604
Mailing Address - Street 1:1220 HERITAGE LAKES DR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1248
Mailing Address - Country:US
Mailing Address - Phone:678-933-3528
Mailing Address - Fax:186-628-1862
Practice Address - Street 1:1254 CONCORD RD SE STE 204
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4371
Practice Address - Country:US
Practice Address - Phone:678-842-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA120106251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health