Healthcare Provider Details

I. General information

NPI: 1841559978
Provider Name (Legal Business Name): COMIZIA CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CLAIREMONT AVE SUITE 200
DECATUR GA
30030-2500
US

IV. Provider business mailing address

2183 SARA ASHLEY WAY
LITHONIA GA
30058-8983
US

V. Phone/Fax

Practice location:
  • Phone: 404-428-1472
  • Fax: 404-492-7466
Mailing address:
  • Phone: 404-428-1472
  • Fax: 404-492-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MIKO JONES
Title or Position: CEO
Credential:
Phone: 404-428-1472