Provider Demographics
NPI:1730221649
Name:COMMUNITY CARE MD
Entity type:Organization
Organization Name:COMMUNITY CARE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-720-0422
Mailing Address - Street 1:5019 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3541
Mailing Address - Country:US
Mailing Address - Phone:678-720-0422
Mailing Address - Fax:678-720-0440
Practice Address - Street 1:5019 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3541
Practice Address - Country:US
Practice Address - Phone:678-720-0422
Practice Address - Fax:678-720-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156221261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6278Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER