Provider Demographics
NPI:1659529873
Name:FORSYTH SPINAL REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:FORSYTH SPINAL REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-888-9265
Mailing Address - Street 1:3320 DAHLONEGA HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3915
Mailing Address - Country:US
Mailing Address - Phone:770-888-9265
Mailing Address - Fax:770-888-9266
Practice Address - Street 1:3320 DAHLONEGA HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-3915
Practice Address - Country:US
Practice Address - Phone:770-888-9265
Practice Address - Fax:770-888-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00335595OtherPALMETTO GBA MEDICARE RR #
GA511G701198Medicare PIN
GAP00335595OtherPALMETTO GBA MEDICARE RR #