Organization
DEVELOPMENTAL & REHABILITATIVE SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE EDWARDS PT (PRESIDENT)
(770) 879-5646
Entity
Organization
Contact information
Practice address
5295 STONE MOUNTAIN HWY, SUITE I, STONE MOUNTAIN, GA 30087-6416
(770) 879-5646
(770) 981-2024
Mailing address
5295 STONE MOUNTAIN HWY, SUITE I, STONE MOUNTAIN, GA 30087-6416
(770) 879-5646
(770) 981-2024
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007234PT
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000950595D
—
GA
01
—
10039295
AMERIGROUP
GA
01
—
309589
WELLCARE
GA
Enumeration date
11/02/2006
Last updated
04/18/2014
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