Provider Demographics
NPI:1326396136
Name:NORTH GEORGIA HAND THERAPY, LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA HAND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:678-780-6941
Mailing Address - Street 1:2920 RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6206
Mailing Address - Country:US
Mailing Address - Phone:770-889-0885
Mailing Address - Fax:770-880-0886
Practice Address - Street 1:765 PEACHTREE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9522
Practice Address - Country:US
Practice Address - Phone:678-780-6941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004063225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I670012Medicare PIN