Healthcare Provider Details

I. General information

NPI: 1912041989
Provider Name (Legal Business Name): MASTERCARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SAMMY MCGHEE BLVD STE. 101
JASPER GA
30143-7711
US

IV. Provider business mailing address

12 SAMMY MCGHEE BLVD STE. 101
JASPER GA
30143-7711
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-3344
  • Fax: 706-253-3348
Mailing address:
  • Phone: 706-253-3344
  • Fax: 706-253-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOHRA MASTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-253-3344