Provider Demographics
NPI:1174856397
Name:CARE DYNAMIX, INC,
Entity Type:Organization
Organization Name:CARE DYNAMIX, INC,
Other - Org Name:FLU BUSTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-512-8566
Mailing Address - Street 1:235 HEMBREE PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5738
Mailing Address - Country:US
Mailing Address - Phone:770-512-8566
Mailing Address - Fax:770-512-8558
Practice Address - Street 1:235 HEMBREE PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5738
Practice Address - Country:US
Practice Address - Phone:770-512-8566
Practice Address - Fax:770-512-8558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE DYNAMIX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, FederalGroup - Multi-Specialty