Healthcare Provider Details

I. General information

NPI: 1609933829
Provider Name (Legal Business Name): CARTERSVILLE OCCUPATIONAL MEDICINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 JOE FRANK HARRIS PKWY SE SUITE 100
CARTERSVILLE GA
30120-2158
US

IV. Provider business mailing address

958 JOE FRANK HARRIS PKWY SE SUITE 100
CARTERSVILLE GA
30120-2158
US

V. Phone/Fax

Practice location:
  • Phone: 770-387-8183
  • Fax: 770-606-2127
Mailing address:
  • Phone: 770-387-8183
  • Fax: 770-606-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN EDWARD MCDONALD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 770-387-8183