Provider Demographics
NPI:1972557437
Name:THE HAND & UPPER EXTREMITY REHABILITATION CENTER OF GEORGIA LLC
Entity Type:Organization
Organization Name:THE HAND & UPPER EXTREMITY REHABILITATION CENTER OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:KEARNEY
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:404-255-1242
Mailing Address - Street 1:980 JOHNSON FERRY RD N.E.
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-255-1242
Mailing Address - Fax:404-256-4669
Practice Address - Street 1:980 JOHNSON FERRY RD N.E.
Practice Address - Street 2:SUITE 1000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-1242
Practice Address - Fax:404-256-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA621111225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5696050001Medicare NSC