Provider Demographics
NPI:1871649525
Name:C & C MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:C & C MEDICAL GROUP, INC.
Other - Org Name:MEDFIRST IMMEDIATE MEDICAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-861-2700
Mailing Address - Street 1:6513 BURR ST
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-4201
Mailing Address - Country:US
Mailing Address - Phone:706-861-2700
Mailing Address - Fax:706-861-2745
Practice Address - Street 1:1384 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4010
Practice Address - Country:US
Practice Address - Phone:706-861-2700
Practice Address - Fax:706-861-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 3359Medicare ID - Type Unspecified