1093989659 NPI number — CARE PHYSICIANS GEORGIA, P.C.

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 1093989659 NPI number — CARE PHYSICIANS GEORGIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE PHYSICIANS GEORGIA, P.C.
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:
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:
1093989659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6160 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Mailing Address:
SUITE A100
Provider Business Mailing Address City Name:
SANDY SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-4578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-391-4274
Provider Business Mailing Address Fax Number:
404-705-0760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Practice Location Address:
SUITE A100
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-4578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-391-4274
Provider Business Practice Location Address Fax Number:
404-705-0760
Provider Enumeration Date:
04/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CBO MANAGER
Authorized Official Telephone Number:
214-389-7362

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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