| Organization Name: | SOVEREIGN REHABILITATION OF GEORGIA, LLC |
| NPI Number: | 1215109749 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALAN J GRODIN (PRESIDENT) |
| Mailing Address: | 3541 Highway 81 Loganville |
| State: | GA US |
| Postal Code: | 300524336 |
| Phone Number: | 6784952990 |
| Fax Number: | 6784952995 |
| NPI Enumeration Date: | 03/25/2008 |
| NPI Last Update Date: | 07/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |