Healthcare Provider Details

I. General information

NPI: 1235121617
Provider Name (Legal Business Name): COMMUNITY ANCILLARY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4769 S MAIN ST
ACWORTH GA
30101-5339
US

IV. Provider business mailing address

PO BOX 1038
ACWORTH GA
30101-8938
US

V. Phone/Fax

Practice location:
  • Phone: 770-974-4277
  • Fax: 770-974-4208
Mailing address:
  • Phone: 770-974-4277
  • Fax: 770-974-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHRE008075
License Number StateGA

VIII. Authorized Official

Name: JAMES LEE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 478-783-1515