Healthcare Provider Details

I. General information

NPI: 1982419883
Provider Name (Legal Business Name): UNITED CHRONIC CARE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 BRADLEY PARK DR STE 500-306
COLUMBUS GA
31904-3620
US

IV. Provider business mailing address

1639 BRADLEY PARK DR STE 500-306
COLUMBUS GA
31904-3620
US

V. Phone/Fax

Practice location:
  • Phone: 888-780-8226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THERON HENRY
Title or Position: OWNER/FOUNDER
Credential:
Phone: 888-780-8226