Healthcare Provider Details

I. General information

NPI: 1447839196
Provider Name (Legal Business Name): CHIMED FIC SA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 FOREST PKWY STE 14
FOREST PARK GA
30297-6110
US

IV. Provider business mailing address

PO BOX 1601
PHENIX CITY AL
36868-1601
US

V. Phone/Fax

Practice location:
  • Phone: 877-495-7773
  • Fax:
Mailing address:
  • Phone: 334-298-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN COOPER
Title or Position: MANAGER
Credential:
Phone: 877-495-7773