Provider Demographics
NPI:1194378745
Name:GEORGIA THERAPY CLINIC, LLC
Entity Type:Organization
Organization Name:GEORGIA THERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-602-6545
Mailing Address - Street 1:1800 PEACHTREE ST NW STE 730
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2511
Mailing Address - Country:US
Mailing Address - Phone:470-481-6200
Mailing Address - Fax:404-257-6297
Practice Address - Street 1:1800 PEACHTREE ST NW STE 730
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2511
Practice Address - Country:US
Practice Address - Phone:470-481-6200
Practice Address - Fax:404-257-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty