Healthcare Provider Details

I. General information

NPI: 1417644261
Provider Name (Legal Business Name): CARE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 S 1ST ST
JESUP GA
31545-0332
US

IV. Provider business mailing address

2804 N OAK ST STE C
VALDOSTA GA
31602-5913
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-3444
  • Fax: 912-427-3411
Mailing address:
  • Phone: 229-241-8925
  • Fax: 229-241-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMES RYAN MOORMAN
Title or Position: OWNER
Credential:
Phone: 229-241-8925