Healthcare Provider Details

I. General information

NPI: 1356719843
Provider Name (Legal Business Name): COMPLETE HEALTHCARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 SUMMIT RIDGE PKWY SUITE 103
DULUTH GA
30096-1622
US

IV. Provider business mailing address

3460 SUMMIT RIDGE PKWY
DULUTH GA
30096-1622
US

V. Phone/Fax

Practice location:
  • Phone: 770-813-0087
  • Fax: 770-813-9006
Mailing address:
  • Phone: 770-813-0087
  • Fax: 770-813-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA

VIII. Authorized Official

Name: MARIE KRUZEL
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 770-813-0087