Healthcare Provider Details

I. General information

NPI: 1336565191
Provider Name (Legal Business Name): CHIMEDICAL MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6487 PIERCE CHAPEL RD UNIT 5
MIDLAND GA
31820-3554
US

IV. Provider business mailing address

6487 PIERCE CHAPEL RD UNIT 5
MIDLAND GA
31820-3554
US

V. Phone/Fax

Practice location:
  • Phone: 706-464-7464
  • Fax: 866-837-9033
Mailing address:
  • Phone: 706-464-7464
  • Fax: 866-837-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. STEPHEN B COOPER
Title or Position: CEO, MANAGING PARTNER
Credential: DC
Phone: 706-464-7464