Healthcare Provider Details

I. General information

NPI: 1386930907
Provider Name (Legal Business Name): COWETA OCCUPATIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HIGHWAY 34 E SUITE 1300
NEWNAN GA
30265-6423
US

IV. Provider business mailing address

1825 HIGHWAY 34 E SUITE 1300
NEWNAN GA
30265-6423
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2121
  • Fax: 770-502-2113
Mailing address:
  • Phone: 770-502-2121
  • Fax: 770-502-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMMY KARVELAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-502-2121