Provider Demographics
NPI:1962081604
Name:CHIMED REHAB SOUTH ATLANTA, LLC
Entity type:Organization
Organization Name:CHIMED REHAB SOUTH ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FACMUAP
Authorized Official - Phone:334-298-7700
Mailing Address - Street 1:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-1601
Mailing Address - Country:US
Mailing Address - Phone:334-298-7700
Mailing Address - Fax:
Practice Address - Street 1:541 FOREST PKWY STE 14
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6110
Practice Address - Country:US
Practice Address - Phone:877-495-7773
Practice Address - Fax:866-537-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty