Provider Demographics
NPI:1306010152
Name:GEORGIA REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:GEORGIA REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-254-7851
Mailing Address - Street 1:3150 HIGHWAY 34 E
Mailing Address - Street 2:PMB140
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2122
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:770-251-8567
Practice Address - Street 1:101 YORKTOWN DR
Practice Address - Street 2:SUITE 211
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1568
Practice Address - Country:US
Practice Address - Phone:770-460-4054
Practice Address - Fax:770-460-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116735Medicare PIN