Provider Demographics
NPI:1598840282
Name:CERTIFIED REHAB OF GEORGIA
Entity Type:Organization
Organization Name:CERTIFIED REHAB OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ASPINWALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-884-8360
Mailing Address - Street 1:302 S GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3122
Mailing Address - Country:US
Mailing Address - Phone:706-884-8360
Mailing Address - Fax:706-884-0265
Practice Address - Street 1:302 S GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3122
Practice Address - Country:US
Practice Address - Phone:706-884-8360
Practice Address - Fax:706-884-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALIC006138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52793122OtherBCBS
GA65BBBTJMedicare ID - Type UnspecifiedMEDI
GAP62632Medicare UPIN