Provider Demographics
NPI:1659405066
Name:REHAB SOUTH
Entity type:Organization
Organization Name:REHAB SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESEDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-877-4599
Mailing Address - Street 1:PO BOX 4147
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0147
Mailing Address - Country:US
Mailing Address - Phone:423-877-4599
Mailing Address - Fax:423-877-5611
Practice Address - Street 1:5000 ALPHA LN
Practice Address - Street 2:SUITE A
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4054
Practice Address - Country:US
Practice Address - Phone:423-877-4599
Practice Address - Fax:423-877-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3106308OtherBLUE CROSE BLUE SHIELD
TN446607Medicare ID - Type UnspecifiedMEDICARE