Healthcare Provider Details

I. General information

NPI: 1124174974
Provider Name (Legal Business Name): COLLEGE PARK REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 JOHN WESLEY AVE
COLLEGE PARK GA
30337-3606
US

IV. Provider business mailing address

99 JESSE HILL JR. DRIVE ROOM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-4155
  • Fax: 404-765-4149
Mailing address:
  • Phone: 404-730-1217
  • Fax: 404-730-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM TURNER
Title or Position: HEALTH DIRECTOR
Credential: D.O.
Phone: 404-730-1202