Healthcare Provider Details

I. General information

NPI: 1043798911
Provider Name (Legal Business Name): GCGA PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 VERNON PLACE SUITE 203
CINCINNATI OH
45219
US

IV. Provider business mailing address

2925 VERNON PLACE SUITE 100
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-6667
  • Fax: 513-872-7625
Mailing address:
  • Phone: 513-751-6667
  • Fax: 513-872-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0232000015
License Number StateOH

VIII. Authorized Official

Name: TERRI KAUFMAN
Title or Position: CREDENTIALS MANAGER
Credential:
Phone: 513-751-6667