Provider Demographics
NPI:1639437726
Name:CAERUS GROUP LLC
Entity Type:Organization
Organization Name:CAERUS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIGGOLETTE
Authorized Official - Middle Name:ANDONTE
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-939-7440
Mailing Address - Street 1:3954 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7411
Mailing Address - Country:US
Mailing Address - Phone:404-939-7440
Mailing Address - Fax:404-248-0422
Practice Address - Street 1:3760 LAVISTA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5615
Practice Address - Country:US
Practice Address - Phone:404-248-0415
Practice Address - Fax:404-248-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8642273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit