Healthcare Provider Details

I. General information

NPI: 1891069704
Provider Name (Legal Business Name): HOSPITALMD OF CARO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N HOOPER ST
CARO MI
48723-1476
US

IV. Provider business mailing address

400 WESTPARK CT SUITE 230
PEACHTREE CITY GA
30269-3571
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-3141
  • Fax:
Mailing address:
  • Phone: 770-631-8478
  • Fax: 770-631-8473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES H BURNETTE
Title or Position: PRESIDENT
Credential:
Phone: 770-631-8478