Provider Demographics
NPI:1467582635
Name:CADUCEUS OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:CADUCEUS OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:770-270-0200
Mailing Address - Street 1:3 CASCADE POINTE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8501
Mailing Address - Country:US
Mailing Address - Phone:404-761-4040
Mailing Address - Fax:404-761-4008
Practice Address - Street 1:535 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1603
Practice Address - Country:US
Practice Address - Phone:404-761-4040
Practice Address - Fax:404-761-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN