Provider Demographics
NPI:1609933829
Name:CARTERSVILLE OCCUPATIONAL MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:CARTERSVILLE OCCUPATIONAL MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-387-8183
Mailing Address - Street 1:958 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2158
Mailing Address - Country:US
Mailing Address - Phone:770-387-8183
Mailing Address - Fax:770-606-2127
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2158
Practice Address - Country:US
Practice Address - Phone:770-387-8183
Practice Address - Fax:770-606-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine