Healthcare Provider Details

I. General information

NPI: 1386970374
Provider Name (Legal Business Name): CFS HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 POTTERY FACTORY DR SUITE A
COMMERCE GA
30529-6682
US

IV. Provider business mailing address

413 POTTERY FACTORY DR SUITE A
COMMERCE GA
30529-6682
US

V. Phone/Fax

Practice location:
  • Phone: 706-423-9449
  • Fax: 706-423-9443
Mailing address:
  • Phone: 706-423-9449
  • Fax: 706-423-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number026067
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number062097
License Number StateGA

VIII. Authorized Official

Name: WALID DIAB
Title or Position: CEO
Credential:
Phone: 706-423-9449