Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Canton, GA
NPI 1326868993 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1326868993
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 10451 Bells Ferry Rd
Canton, GA 30114-1293 - Phone
- (479) 201-6091
- NPI assigned
- Oct 16, 2024
- Organization subpart
- No
Authorized official
- Name
- Tracy McCall
- Title
- Credentialing
- Phone
- (479) 201-6091
Other NPIs on the same Medicare enrollment 37
Corporate family (same tax ID) 5
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
- Tax ID family
- Aegis Group Practice
Locations
10451 Bells Ferry Rd
Canton, GA 30114
Phone (470) 508-8819
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
10451 Bells Ferry Rd
Canton, GA 30114-1293
Mailing address
4933 Old Greenwood Rd
Fort Smith, AR 72903-6906
Phone (479) 201-6091
Other providers in Canton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. 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.