Healthcare Provider Details

I. General information

NPI: 1164774667
Provider Name (Legal Business Name): PHYSICIAN ON-CALL NOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9569 ENGLISH IVY CT
FORTSON GA
31808-6962
US

IV. Provider business mailing address

9569 ENGLISH IVY CT
FORTSON GA
31808-6962
US

V. Phone/Fax

Practice location:
  • Phone: 571-247-1876
  • Fax:
Mailing address:
  • Phone: 571-247-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number065088
License Number StateGA

VIII. Authorized Official

Name: DR. KEVIN ALLEN CARTER
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 571-247-1876