Provider Demographics
NPI:1174164388
Name:NORMAN FARMS LLC
Entity type:Organization
Organization Name:NORMAN FARMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:478-719-6639
Mailing Address - Street 1:4220 GAUNTT RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0600
Mailing Address - Country:US
Mailing Address - Phone:478-719-6639
Mailing Address - Fax:
Practice Address - Street 1:4220 GAUNTT RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-0600
Practice Address - Country:US
Practice Address - Phone:478-719-6639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT011383OtherGA PT LICENSE