Healthcare Provider Details

I. General information

NPI: 1740547447
Provider Name (Legal Business Name): TOTAL HEALTHCARE OF LAGRANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3452 HOGANSVILLE RD SUITE B
LAGRANGE GA
30241-8269
US

IV. Provider business mailing address

3452 HOGANSVILLE RD SUITE B
LAGRANGE GA
30241-8269
US

V. Phone/Fax

Practice location:
  • Phone: 706-302-3097
  • Fax: 866-571-7675
Mailing address:
  • Phone: 706-302-3097
  • Fax: 866-571-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CHRISTOPHER SMITH
Title or Position: OWNER
Credential: OWNER
Phone: 706-594-1346