Healthcare Provider Details

I. General information

NPI: 1255323788
Provider Name (Legal Business Name): COMMUNITY ANCILLARY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 INDUSTRIAL BLVD SUITE A
HAWKINSVILLE GA
31036-2106
US

IV. Provider business mailing address

PO BOX 997
HAWKINSVILLE GA
31036-0997
US

V. Phone/Fax

Practice location:
  • Phone: 478-783-1515
  • Fax: 478-783-1404
Mailing address:
  • Phone: 478-783-1515
  • Fax: 478-783-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES RUSTY LEE JR.
Title or Position: SENIOR VICE PRESIDENT
Credential: RPH
Phone: 478-783-1515