Georgia Geriatrics and Rehabilitation

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

GEORGIA GERIATRICS AND REHABILITATION

Practice address

549 Country Club Dr
Stockbridge, GA 30281-6347

Phone

(404) 438-7445

NPI assigned

May 6, 2018

Last updated

Nov 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Willie David Beavers III, PT, DPT, GCSNPI 1336554955

Title

Owner

Phone

(404) 438-7445

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Willie David Beavers III, PT, DPT, GCS

  • Geriatric Physical Therapist
  • Stockbridge, GA
  • NPI 1336554955
  Authorized official Same address or phone

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

{
    "created_epoch": "1525564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1972092955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 COUNTRY CLUB DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 COUNTRY CLUB DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816347",
            "telephone_number": "404-438-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA GERIATRICS AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-06",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-438-7445",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "PT, DPT, GCS"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.