Provider Demographics
NPI:1568193761
Name:GA CENTRAL REHAB CLINIC LLC
Entity Type:Organization
Organization Name:GA CENTRAL REHAB CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:470-550-9101
Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3068
Mailing Address - Country:US
Mailing Address - Phone:470-550-9101
Mailing Address - Fax:800-886-9987
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD STE J
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3068
Practice Address - Country:US
Practice Address - Phone:470-550-9101
Practice Address - Fax:800-886-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty