Provider Demographics
NPI:1699085886
Name:NORTH GEORGIA PHYSICAL THERAPY
Entity type:Organization
Organization Name:NORTH GEORGIA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-632-8535
Mailing Address - Street 1:5425 APPALACHIAN HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:706-632-8535
Mailing Address - Fax:
Practice Address - Street 1:97 HEFNER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-635-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0864130002Medicare NSC