Provider Demographics
NPI:1720070709
Name:CARE MEDICAL OF GEORGIA
Entity Type:Organization
Organization Name:CARE MEDICAL OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TANDRA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-468-5903
Mailing Address - Street 1:1572 HIGHWAY 85N
Mailing Address - Street 2:SUITE 505
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7729
Mailing Address - Country:US
Mailing Address - Phone:678-228-2849
Mailing Address - Fax:678-228-1636
Practice Address - Street 1:1572 HIGHWAY 85N
Practice Address - Street 2:SUITE 505
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7729
Practice Address - Country:US
Practice Address - Phone:678-228-2849
Practice Address - Fax:678-228-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA146697898AMedicaid
GA5554320001Medicare NSC