Healthcare Provider Details

I. General information

NPI: 1083240766
Provider Name (Legal Business Name): CAREHERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N JACKSON ST
ALBANY GA
31701-2583
US

IV. Provider business mailing address

114 N JACKSON ST
ALBANY GA
31701-2583
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-5901
  • Fax:
Mailing address:
  • Phone: 615-221-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST CLEVENGER
Title or Position: PRESIDENT
Credential:
Phone: 615-221-5901