Provider Demographics
NPI:1689319428
Name:SOUTHWEST GEORGIA REHAB, INC
Entity Type:Organization
Organization Name:SOUTHWEST GEORGIA REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-9445
Mailing Address - Street 1:1107 GREER ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-1921
Mailing Address - Country:US
Mailing Address - Phone:229-273-9445
Mailing Address - Fax:
Practice Address - Street 1:107 S 3RD ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1511
Practice Address - Country:US
Practice Address - Phone:229-273-9445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GEORGIA REHAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty