Provider Demographics
NPI:1588836019
Name:SOVEREIGN REHABILITATION OF GEORGIA, LLC
Entity type:Organization
Organization Name:SOVEREIGN REHABILITATION OF GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICE CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-835-3343
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1703
Mailing Address - Country:US
Mailing Address - Phone:404-835-3343
Mailing Address - Fax:404-207-1391
Practice Address - Street 1:439 SIGMAN RD NW
Practice Address - Street 2:SUITE D
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3653
Practice Address - Country:US
Practice Address - Phone:678-210-0311
Practice Address - Fax:678-210-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy