Provider Demographics
NPI:1790169910
Name:GEORGIA COMPLETE CARE CENTERS LLC
Entity Type:Organization
Organization Name:GEORGIA COMPLETE CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-831-1155
Mailing Address - Street 1:245 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9126
Mailing Address - Country:US
Mailing Address - Phone:770-831-1155
Mailing Address - Fax:
Practice Address - Street 1:245 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-9126
Practice Address - Country:US
Practice Address - Phone:770-831-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007907111N00000X
GACHIR007581111NN0400X
GAGA040613207R00000X
GAPT006386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJJNMedicare PIN