Healthcare Provider Details

I. General information

NPI: 1003032368
Provider Name (Legal Business Name): C & C MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAINT SEBASTIAN WAY SUITE 8A
AUGUSTA GA
30901-2643
US

IV. Provider business mailing address

PO BOX 3842 1125 TROUPE STREET
AUGUSTA GA
30914-3842
US

V. Phone/Fax

Practice location:
  • Phone: 706-396-6325
  • Fax: 706-722-7454
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSEMARIE CLASSI
Title or Position: PARTNER
Credential: M.D.
Phone: 706-737-4575