Provider Demographics
NPI:1245390681
Name:CARITAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CARITAS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OVADJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-284-0800
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8909
Mailing Address - Country:US
Mailing Address - Phone:678-284-0800
Mailing Address - Fax:678-284-0393
Practice Address - Street 1:105 N PARK TRL
Practice Address - Street 2:STE 300
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7373
Practice Address - Country:US
Practice Address - Phone:678-284-0800
Practice Address - Fax:678-284-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055143207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH49123Medicare UPIN
GA39BCDCJLMedicare ID - Type Unspecified