Provider Demographics
NPI:1225117047
Name:CAHABA MEDICAL CARE, PC
Entity Type:Organization
Organization Name:CAHABA MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-926-2992
Mailing Address - Street 1:195 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2935
Mailing Address - Country:US
Mailing Address - Phone:205-926-2992
Mailing Address - Fax:205-926-2993
Practice Address - Street 1:195 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2935
Practice Address - Country:US
Practice Address - Phone:205-926-2992
Practice Address - Fax:205-926-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25230261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care