Provider Demographics
NPI:1760097539
Name:STATCARE GROUP LLC
Entity Type:Organization
Organization Name:STATCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-679-6471
Mailing Address - Street 1:1275 HIGHWAY 54 W STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11804 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3311
Practice Address - Country:US
Practice Address - Phone:410-870-5094
Practice Address - Fax:410-870-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care