Provider Demographics
NPI:1063853364
Name:CMO OF GEORGIA, LLC
Entity Type:Organization
Organization Name:CMO OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALCENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-664-6183
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-0258
Mailing Address - Country:US
Mailing Address - Phone:404-664-6183
Mailing Address - Fax:
Practice Address - Street 1:6728 CHESEPEAKE TRL
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2229
Practice Address - Country:US
Practice Address - Phone:404-664-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLEMAN ENTERPRISES & ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163373251B00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care