Provider Demographics
NPI:1922016187
Name:C J MEDICAL CENTER, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:C J MEDICAL CENTER, PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-232-9525
Mailing Address - Street 1:3540 DULUTH PARK LN
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6674
Mailing Address - Country:US
Mailing Address - Phone:770-232-9525
Mailing Address - Fax:770-232-9106
Practice Address - Street 1:3540 DULUTH PARK LN
Practice Address - Street 2:SUITE # 250
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6674
Practice Address - Country:US
Practice Address - Phone:770-232-9525
Practice Address - Fax:770-232-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0297942081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty