Aegis Group Practice LLC
Organization Active NPI Occupational Therapist · Atlanta, GA
NPI 1083148985 · NPPES record last updated Nov 23, 2021
Key facts
- NPI
- 1083148985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Occupational Therapist 225X00000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 1825 Clifton Rd NE
Atlanta, GA 30329-4047 - Phone
- (479) 201-2000
- Fax
- (479) 201-4801
- NPI assigned
- Apr 18, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- AEGIS THERAPIES, INC.
Authorized official
- Name
- Michael McOlvin
- Title
- Director
- Phone
- (479) 201-2000
Other NPIs on the same Medicare enrollment 37
Practitioners 1
-
Cherie Dempster, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150916001644 | GA | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 34 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Canton, GA; Suwanee, GA |
National Provider Directory
- Part of
- Aegis
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | Yes | ||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
1825 Clifton Rd NE
Atlanta, GA 30329-4047
Mailing address
4933 Old Greenwood Rd
Fort Smith, AR 72903-6906
Phone (479) 201-6147
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.