Provider Demographics
NPI:1912041989
Name:MASTERCARE MEDICAL CENTER
Entity Type:Organization
Organization Name:MASTERCARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-253-3344
Mailing Address - Street 1:12 SAMMY MCGHEE BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7711
Mailing Address - Country:US
Mailing Address - Phone:706-253-3344
Mailing Address - Fax:706-253-3348
Practice Address - Street 1:12 SAMMY MCGHEE BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7711
Practice Address - Country:US
Practice Address - Phone:706-253-3344
Practice Address - Fax:706-253-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCCNWMedicare PIN
GAH09084Medicare UPIN