Healthcare Provider Details

I. General information

NPI: 1962052167
Provider Name (Legal Business Name): CAAP MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SUNSET DR STE 601
ATHENS GA
30606-7720
US

IV. Provider business mailing address

700 SUNSET DR STE 601
ATHENS GA
30606-7720
US

V. Phone/Fax

Practice location:
  • Phone: 706-549-4155
  • Fax:
Mailing address:
  • Phone: 706-549-4155
  • Fax: 706-549-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS KATELYN COLE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 706-247-5605