Healthcare Provider Details

I. General information

NPI: 1902262629
Provider Name (Legal Business Name): CARECONNECT HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BROAD ST
HAWKINSVILLE GA
31036-4818
US

IV. Provider business mailing address

259 BROAD ST
HAWKINSVILLE GA
31036-4818
US

V. Phone/Fax

Practice location:
  • Phone: 478-783-9340
  • Fax: 478-783-3961
Mailing address:
  • Phone: 478-783-9340
  • Fax: 478-783-3961

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