1649810714 NPI number — CARECONNECT HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649810714 NPI number — CARECONNECT HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARECONNECT HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARECONNECT FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649810714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31010-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-273-8881
Provider Business Mailing Address Fax Number:
229-273-8985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 WRIGHT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBERTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-384-5576
Provider Business Practice Location Address Fax Number:
229-384-5527
Provider Enumeration Date:
01/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE SECRETARY
Authorized Official Telephone Number:
229-273-8881

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ========= . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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