Healthcare Provider Details

I. General information

NPI: 1962055152
Provider Name (Legal Business Name): CAREHALO OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 DUPONT CIRCLE DR. SUITE 201
FORT WAYNE IN
46825
US

IV. Provider business mailing address

5200 DALLAS HWY STE 200-243
POWDER SPRINGS GA
30127-6318
US

V. Phone/Fax

Practice location:
  • Phone: 770-364-2184
  • Fax:
Mailing address:
  • Phone: 770-364-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA GOINS
Title or Position: PRESIDENT
Credential:
Phone: 770-364-2184