Basic Information
| Provider Information | |||||||||
| NPI: | 1366450710 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL GEORGIA REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3351 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312102587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782016500 | ||||||||
| FaxNumber: | 4787570835 | ||||||||
| Practice Location | |||||||||
| Address1: | 3351 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782016500 | ||||||||
| FaxNumber: | 4787570835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHREWSBURY | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4786331452 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 011-561 | GA | Y | Hospitals | Rehabilitation Hospital |
No ID Information.