Healthcare Provider Details

I. General information

NPI: 1043440340
Provider Name (Legal Business Name): CARECONNECT HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 GRIFFIN AVE
EASTMAN GA
31023-6718
US

IV. Provider business mailing address

P.O. BOX 5610
CORDELE GA
31010-1514
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-1801
  • Fax: 478-448-4586
Mailing address:
  • Phone: 229-273-8881
  • Fax: 229-273-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LINDA YOUNG
Title or Position: SECRETARY
Credential:
Phone: 229-273-8881