Provider Demographics
NPI:1972519106
Name:CONCORD INC
Entity Type:Organization
Organization Name:CONCORD INC
Other - Org Name:CONCORD DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-671-0657
Mailing Address - Street 1:8046 ROSWELL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-7023
Mailing Address - Country:US
Mailing Address - Phone:770-671-0657
Mailing Address - Fax:770-393-0835
Practice Address - Street 1:993-D JOHNSON FERRY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-0526
Practice Address - Fax:404-255-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0060623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00890458-AMedicaid