Provider Demographics
NPI:1891243960
Name:METRO COMMUNITY HEALTHCARE LLC
Entity Type:Organization
Organization Name:METRO COMMUNITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-580-5958
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6932
Mailing Address - Country:US
Mailing Address - Phone:678-580-5958
Mailing Address - Fax:770-807-0878
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 418
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6932
Practice Address - Country:US
Practice Address - Phone:678-580-5958
Practice Address - Fax:770-807-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700815Medicare PIN