Healthcare Provider Details

I. General information

NPI: 1457262214
Provider Name (Legal Business Name): CHRONIC CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE H202
COLUMBUS GA
31904-6803
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE H202
COLUMBUS GA
31904-6803
US

V. Phone/Fax

Practice location:
  • Phone: 706-257-7680
  • Fax:
Mailing address:
  • Phone: 706-257-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY RUSSELL
Title or Position: OWNER
Credential:
Phone: 337-315-7927