Provider Demographics
NPI:1699860817
Name:WALTON REHABILTATION HOSPITAL
Entity Type:Organization
Organization Name:WALTON REHABILTATION HOSPITAL
Other - Org Name:WALTON REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:706-724-7746
Mailing Address - Street 1:1355 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1037
Mailing Address - Country:US
Mailing Address - Phone:706-724-7746
Mailing Address - Fax:706-823-8681
Practice Address - Street 1:1355 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1037
Practice Address - Country:US
Practice Address - Phone:706-724-7746
Practice Address - Fax:706-823-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121421283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003683879Medicaid
GA113026Medicare ID - Type UnspecifiedMEDICARE I.D. #