Provider Demographics
NPI:1215247465
Name:MILESTONE THERAPY OF GEORGIA, LLC
Entity type:Organization
Organization Name:MILESTONE THERAPY OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKHART
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:706-955-3000
Mailing Address - Street 1:730 CIRRUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7997
Mailing Address - Country:US
Mailing Address - Phone:706-955-3000
Mailing Address - Fax:770-752-7131
Practice Address - Street 1:730 CIRRUS DRIVE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7997
Practice Address - Country:US
Practice Address - Phone:706-955-3000
Practice Address - Fax:770-752-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006194251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA345350336BMedicaid