Provider Demographics
NPI:1164045548
Name:MY CHRONIC CARE MANAGEMENT
Entity Type:Organization
Organization Name:MY CHRONIC CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-309-5200
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-9102
Mailing Address - Country:US
Mailing Address - Phone:770-635-7166
Mailing Address - Fax:404-591-8002
Practice Address - Street 1:20 WHITLOCK PL SW STE 101
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3176
Practice Address - Country:US
Practice Address - Phone:770-635-7166
Practice Address - Fax:404-591-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies