MEDICARE: CAREHERE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1083240766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREHERE LLC

Provider Business Mailing Address
First Line	:	114 N JACKSON ST
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-2583
Country	:	US
Telephone Number	:	615-221-5901
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 N JACKSON ST
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-2583
Country	:	US
Telephone Number	:	615-221-5901
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERNEST CLEVENGER
Credential	:
Telephone Number	:	615-221-5901

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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Directions to “CAREHERE LLC ” Practice Location

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