Provider Demographics
NPI:1558625319
Name:CORACCESS, INC
Entity Type:Organization
Organization Name:CORACCESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:678-462-9734
Mailing Address - Street 1:1478 LEAFVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2112
Mailing Address - Country:US
Mailing Address - Phone:678-462-9734
Mailing Address - Fax:
Practice Address - Street 1:1478 LEAFVIEW RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2112
Practice Address - Country:US
Practice Address - Phone:678-462-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003373363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA363A00000XOtherTAXONOMY
GA363A00000XOtherTAXONOMY