Healthcare Provider Details

I. General information

NPI: 1508227141
Provider Name (Legal Business Name): COMPASSION COMMUNITY PCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 APPLING HARLEM RD
APPLING GA
30802-3723
US

IV. Provider business mailing address

1942 APPLING HARLEM RD
APPLING GA
30802-3723
US

V. Phone/Fax

Practice location:
  • Phone: 762-354-7007
  • Fax: 762-354-7007
Mailing address:
  • Phone: 762-354-7007
  • Fax: 762-354-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. DELOOIS HILL
Title or Position: OWNER/OPERATOR
Credential:
Phone: 762-354-7007