Provider Demographics
NPI:1487838066
Name:SOUTHERN THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:SOUTHERN THERAPY SERVICES, INC
Other - Org Name:SOUTHERN THERAPY CARROLLTON DME
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:770-832-2484
Mailing Address - Street 1:812 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4412
Mailing Address - Country:US
Mailing Address - Phone:770-834-7436
Mailing Address - Fax:770-930-5954
Practice Address - Street 1:812 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4412
Practice Address - Country:US
Practice Address - Phone:770-834-7436
Practice Address - Fax:770-930-5954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN THERAPY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-19
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4492740001Medicare NSC