Healthcare Provider Details

I. General information

NPI: 1568385409
Provider Name (Legal Business Name): COMMUNITY CARE PATHWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 E JOHNS XING STE 160
JOHNS CREEK GA
30097-1500
US

IV. Provider business mailing address

990 PEACHTREE INDUSTRIAL BLVD UNIT 1207
SUWANEE GA
30024-5209
US

V. Phone/Fax

Practice location:
  • Phone: 770-988-4956
  • Fax: 770-988-4956
Mailing address:
  • Phone: 770-988-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: KOEKLAND THOMAS
Title or Position: FOUNDER
Credential:
Phone: 770-988-4956