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General NPI Number Information
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NPI Number | 1043352958
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Entity Type | Organization
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Legal Business Name | CESAR CLINIC, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1497 FAIR RD SUITE 201
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City | STATESBORO
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State | GA
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Zip | 30458-0822
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Country | US
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Telephone | 912-871-8500
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Fax | 912-871-8508
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Provider Business Mailing Address
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Address Line | 1497 FAIR RD SUITE 201
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City | STATESBORO
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State | GA
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Zip | 30458-0822
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Country | US
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Telephone | 912-871-8500
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Fax | 912-871-8508
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSE L CESAR
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Credential | M.D.
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Telephone | 912-871-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F63922
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License Number State | GA
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