Healthcare Provider Details

I. General information

NPI: 1417146408
Provider Name (Legal Business Name): INFORMED CARE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 12TH ST SUITE 800
COLUMBUS GA
31901-2462
US

IV. Provider business mailing address

PO BOX 6250
CHARLOTTESVILLE VA
22906-6250
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-4882
  • Fax: 407-786-4011
Mailing address:
  • Phone: 877-800-4882
  • Fax: 407-786-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024342
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNO60198 NP
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN088485
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN150783
License Number StateGA

VIII. Authorized Official

Name: MARY CONSOLATO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 877-800-4882