Provider Demographics
NPI:1174958706
Name:CORRECTIONAL MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:CORRECTIONAL MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-760-0296
Mailing Address - Street 1:1000 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 060
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3026
Mailing Address - Country:US
Mailing Address - Phone:404-760-0296
Mailing Address - Fax:404-760-0298
Practice Address - Street 1:1000 CIRCLE 75 PKWY SE
Practice Address - Street 2:SUITE 060
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3026
Practice Address - Country:US
Practice Address - Phone:404-760-0296
Practice Address - Fax:404-760-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAJ702424311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility