Provider Demographics
NPI:1598052706
Name:COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER, INC.
Other - Org Name:GRASSROOTS MEDICAL, GRASSROOTS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMEN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:ATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-398-6548
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0340
Mailing Address - Country:US
Mailing Address - Phone:678-398-6548
Mailing Address - Fax:
Practice Address - Street 1:4485 N TOWN SQ
Practice Address - Street 2:SUITE 108
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2242
Practice Address - Country:US
Practice Address - Phone:678-398-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003141372AMedicaid
GA003141372AMedicaid