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General NPI Number Information
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NPI Number | 1003855917
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Entity Type | Organization
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Legal Business Name | CENTER FOR COLORECTAL CARE LLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 1800 TREE LN SUITE 270
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City | SNELLVILLE
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State | GA
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Zip | 30078-2016
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Country | US
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Telephone | 678-344-6303
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 TREE LN SUITE 270
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City | SNELLVILLE
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State | GA
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Zip | 30078-2016
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Country | US
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Telephone | 678-344-6303
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Fax |
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Authorized Official
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Title or Position | VP
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Name | MARK PICKETT
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Credential |
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Telephone | 678-344-6303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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