Provider Demographics
NPI:1063749091
Name:PACESETTER PT SERVICES, INC
Entity type:Organization
Organization Name:PACESETTER PT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-271-9184
Mailing Address - Street 1:2729 BLACK SHOALS RD NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1901
Mailing Address - Country:US
Mailing Address - Phone:404-271-9184
Mailing Address - Fax:
Practice Address - Street 1:2729 BLACK SHOALS RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-1901
Practice Address - Country:US
Practice Address - Phone:404-271-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1215176730Medicare UPIN