NPIMap

Organization Active NPI

Sovereign Rehabilitation of Georgia, LLC

Doing business as Centers for Orthopedic Rehabilitation

  • Physical Therapist
  • Atlanta, GA
National Provider Identifier
1376756197
Registry record updated Jul 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT001153 Issued in GA
Legal business name
SOVEREIGN REHABILITATION OF GEORGIA, LLC
Doing business as
Centers for Orthopedic Rehabilitation
Practice address
5555 Peachtree Dunwoody Rd NE
Suite 201
Atlanta, GA 30342-1703
Phone
(404) 835-3340
Fax
(404) 207-1391
NPI assigned
May 8, 2007
Last updated
Jul 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alan J Grodin, PT
Title
President
Phone
(404) 835-3340

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT001153 GA Primary
Hand Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XH1200X OT004558 GA

Addresses

Primary practice location

5555 Peachtree Dunwoody Rd NE
Suite 201
Atlanta, GA 30342-1703

Mailing address

5555 Peachtree Dunwoody Rd NE
Suite 201
Atlanta, GA 30342-1703
Phone (404) 835-3340

Other names 1

  • Centers for Orthopedic Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376756197. Details of each certification follow.

  • CCN 116873 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 116873

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOVEREIGN REHABILITATION OF GEORGIA
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Dec 14, 2007
Last certification
Mar 9, 2017
Ownership / control type
Proprietary
Facility address
5555 Peachtree Dunwoody Road Ste 225
Atlanta, GA 30342

National Provider Directory

National Provider Directory

Locations

420 Northside Cherokee Blvd
Ste 190
Canton, GA 30115

4114 Mill St NE
Covington, GA 30014
Phone (770) 787-6113

100 Stoneforest Dr
Ste 210
Woodstock, GA 30189
Phone (678) 210-0311

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216425600000",
    "number": "1376756197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 201",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421703",
            "telephone_number": "404-835-3340",
            "fax_number": "404-207-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 201",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421703",
            "telephone_number": "404-835-3340",
            "fax_number": "404-207-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN REHABILITATION OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2008-07-19",
        "status": "A",
        "authorized_official_last_name": "GRODIN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-835-3340",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT001153",
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": "GA",
            "license": "OT004558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centers for Orthopedic Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.