Provider Demographics
NPI:1942900113
Name:C&C EXPRESS URGENT CARE LLC
Entity Type:Organization
Organization Name:C&C EXPRESS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NKONGHO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-491-6813
Mailing Address - Street 1:773 HIGHWAY 138 SW STE 1
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1599
Mailing Address - Country:US
Mailing Address - Phone:240-491-6813
Mailing Address - Fax:
Practice Address - Street 1:773 HIGHWAY 138 SW STE 1
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1599
Practice Address - Country:US
Practice Address - Phone:240-491-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care