Provider Demographics
NPI:1831313683
Name:COMPREHENSIVE CARE MEDICAL L.L.C
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE MEDICAL L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-439-0198
Mailing Address - Street 1:4052 ATLANTA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2693
Mailing Address - Country:US
Mailing Address - Phone:770-439-0198
Mailing Address - Fax:770-439-0297
Practice Address - Street 1:4052 ATLANTA ST
Practice Address - Street 2:SUITE C
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2693
Practice Address - Country:US
Practice Address - Phone:770-439-0198
Practice Address - Fax:770-439-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016356208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty