Provider Demographics
NPI:1801572003
Name:CARITAS MEDICAL CENTER FAYETTEVILLE LLC
Entity type:Organization
Organization Name:CARITAS MEDICAL CENTER FAYETTEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVADJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-284-0800
Mailing Address - Street 1:105 N PARK TRL STE 300
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7432
Mailing Address - Country:US
Mailing Address - Phone:678-284-0800
Mailing Address - Fax:678-284-9299
Practice Address - Street 1:105 N PARK TRL STE 300
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7432
Practice Address - Country:US
Practice Address - Phone:678-284-0800
Practice Address - Fax:678-284-9299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARITAS MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty