Healthcare Provider Details

I. General information

NPI: 1639437726
Provider Name (Legal Business Name): CAERUS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 LAVISTA RD SUITE 102
TUCKER GA
30084-5615
US

IV. Provider business mailing address

3954 JERICHO RD
TUCKER GA
30084-7411
US

V. Phone/Fax

Practice location:
  • Phone: 404-248-0415
  • Fax: 404-248-0422
Mailing address:
  • Phone: 404-939-7440
  • Fax: 404-248-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number8642
License Number StateGA

VIII. Authorized Official

Name: DR. RIGGOLETTE ANDONTE LEEPER JR.
Title or Position: OWNER
Credential: DPT
Phone: 404-939-7440