Provider Demographics
NPI:1366450710
Name:CENTRAL GEORGIA REHABILITATION
Entity Type:Organization
Organization Name:CENTRAL GEORGIA REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREWSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:3351 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2587
Mailing Address - Country:US
Mailing Address - Phone:478-201-6500
Mailing Address - Fax:478-757-0835
Practice Address - Street 1:3351 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-201-6500
Practice Address - Fax:478-757-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-561283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G706464OtherMEDICARE PART B PTAN
GA202G706464OtherMEDICARE PART B PTAN