Provider Demographics
NPI:1821008087
Name:NORTHEAST GEORGIA REHABILITATION CENTER,INC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA REHABILITATION CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEADLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-246-0542
Mailing Address - Street 1:651 COOK ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3905
Mailing Address - Country:US
Mailing Address - Phone:706-246-0542
Mailing Address - Fax:706-246-0543
Practice Address - Street 1:651 COOK ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3905
Practice Address - Country:US
Practice Address - Phone:706-246-0542
Practice Address - Fax:706-246-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6855Medicare ID - Type UnspecifiedGROUP PROVIDER #