Healthcare Provider Details

I. General information

NPI: 1457797938
Provider Name (Legal Business Name): PERFECT HEALTH ALWAYS ON CALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2013
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 WASHINGTON RD
EVANS GA
30809
US

IV. Provider business mailing address

PO BOX 509
GROVETOWN GA
30813
US

V. Phone/Fax

Practice location:
  • Phone: 706-760-7607
  • Fax: 706-760-7605
Mailing address:
  • Phone: 706-760-7607
  • Fax: 706-760-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number056422
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number056422
License Number StateGA

VIII. Authorized Official

Name: DR. TROY PAUL COON
Title or Position: PHYSICIAN
Credential: MD
Phone: 762-218-3627