Healthcare Provider Details

I. General information

NPI: 1003891383
Provider Name (Legal Business Name): CG MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CONNELL RD
VALDOSTA GA
31602-1471
US

IV. Provider business mailing address

385 CONNELL RD
VALDOSTA GA
31602-1471
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-6788
  • Fax: 229-244-9667
Mailing address:
  • Phone: 229-244-6788
  • Fax: 229-244-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8939
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number8184
License Number StateGA

VIII. Authorized Official

Name: ED COCKMAN
Title or Position: CO-OWNER
Credential:
Phone: 229-244-6788