St. Mary Spine and Sport Injuries Rehab
Organization Active NPI Internal Medicine Physician · Bloomingdale, GA
NPI 1992479596 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1992479596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ST. MARY SPINE AND SPORT INJURIES REHAB
- Practice address
- 502 E US Highway 80 Ste D
Bloomingdale, GA 31302-9356 - Phone
- (912) 999-7275
- Fax
- (912) 988-3748
- NPI assigned
- Aug 6, 2021
- Organization subpart
- No
Authorized official
- Name
- Noha Raouf Soliman, DO
- Title
- Provider/Owner
- Phone
- (912) 508-8828
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211201002888 | GA | Part B Supplier - Clinic/Group Practice | 1456757889 |
Receives reassigned benefits from 1 practitioner Practice locations: Bloomingdale, GA; Pooler, GA |
National Provider Directory
Locations
502 E US Highway 80
Ste D
Bloomingdale, GA 31302
Phone (912) 999-7275
52 Traders Way
Pooler, GA 31322
Phone (912) 998-7275
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Physical Therapist |
225100000X |
Addresses
Primary practice location
502 E US Highway 80 Ste D
Bloomingdale, GA 31302-9356
Mailing address
502 E US Highway 80 Ste D
Bloomingdale, GA 31302-9356
Other practice location 1
52 Traders Way
Pooler, GA 31322-4158
Phone (912) 999-7275
Other providers in Bloomingdale, GA
- Lauren Ivey Shiver
- Noha Raouf Soliman
- Sydney Sorrells
- Southern Pediatric Speech Therapy LLC
- Margaret Ann Spivey
- Hanna Sukenik
- Walker Health and Wellness LLC
- Rebecca Rose Webb
- Wee Care Pediatric Therapy, LLC
- Whitney Simone Wiley
All providers in Bloomingdale, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 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.