1003287616 NPI number — WORLDCARE INTERNATIONAL CORPORATION

Table of content: (NPI 1003287616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003287616 NPI number — WORLDCARE INTERNATIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORLDCARE INTERNATIONAL CORPORATION
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:
Provider Other Organization Name Type Code:
6
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:
1003287616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 ASHVILLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31210-1669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-474-4035
Provider Business Mailing Address Fax Number:
478-474-7713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 BILLY WILLIAMSON DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31206-8743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-538-3708
Provider Business Practice Location Address Fax Number:
478-474-7713
Provider Enumeration Date:
10/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DUMELOD
Authorized Official First Name:
JUDIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
478-474-4035

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  002435 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000760702B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000760702F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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