MEDICARE: NORTH GEORGIA COMMUNITY CARE NETWORK, LTD. CO.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1649734013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GEORGIA COMMUNITY CARE NETWORK, LTD. CO.

Provider Business Mailing Address
First Line	:	3710 GADOLINITE TRL
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-6181
Country	:	US
Telephone Number	:	404-551-4611
Fax Number	:	404-551-4697

Provider Business Practice Location Address
First Line	:	1372 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3203
Country	:	US
Telephone Number	:	404-551-4611
Fax Number	:	404-551-4697

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MATTHEW DIXON
Credential	:	, MSW, CCM
Telephone Number	:	404-551-4611

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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