Provider Demographics
NPI:1750322608
Name:APEX1
Entity Type:Organization
Organization Name:APEX1
Other - Org Name:MOMENTUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-507-3794
Mailing Address - Street 1:3075 TOWER RD
Mailing Address - Street 2:SUITA A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2536
Mailing Address - Country:US
Mailing Address - Phone:706-507-3794
Mailing Address - Fax:706-507-3681
Practice Address - Street 1:3075 TOWER RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2536
Practice Address - Country:US
Practice Address - Phone:706-507-3794
Practice Address - Fax:706-507-3681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APEX1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7780Medicare PIN