MEDICARE: STATCARE GROUP 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1730770074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATCARE GROUP LLC

Provider Business Mailing Address
First Line	:	1275 HIGHWAY 54 W STE 201
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4538
Country	:	US
Telephone Number	:	678-679-6471
Fax Number	:

Provider Business Practice Location Address
First Line	:	7663 ARUNDEL MILLS BLVD
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1305
Country	:	US
Telephone Number	:	815-986-2311
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING OPERATIONS
Name	:	SHANDI FAULK
Credential	:
Telephone Number	:	678-679-6471

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	03/30/2021

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