Healthcare Provider Details

I. General information

NPI: 1083183180
Provider Name (Legal Business Name): CARECONNECT HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

IV. Provider business mailing address

PO BOX 5610
CORDELE GA
31010-5610
US

V. Phone/Fax

Practice location:
  • Phone: 678-688-2820
  • Fax: 770-467-9868
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: EXECUTIVE SECRETARY
Credential:
Phone: 229-273-8881