Healthcare Provider Details

I. General information

NPI: 1588383392
Provider Name (Legal Business Name): CAAP MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 OLD PENDERGRASS ROAD SUITE 340
JEFFERSON GA
30549-2716
US

IV. Provider business mailing address

1181 LANGFORD DR BUILDING 100 STE 103
WATKINSVILLE GA
30677-7242
US

V. Phone/Fax

Practice location:
  • Phone: 706-708-2344
  • Fax: 706-708-2342
Mailing address:
  • Phone: 706-208-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A HARRIS
Title or Position: DIRECTOR
Credential:
Phone: 706-208-1990