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General NPI Number Information
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NPI Number | 1063172625
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Entity Type | Organization
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Legal Business Name | CENTENNIAL JOINT CARE INC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 4700 NELSON BROGDON BLVD STE 220
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City | BUFORD
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State | GA
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Zip | 30518-5401
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Country | US
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Telephone | 770-904-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 NELSON BROGDON BLVD STE 210
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City | BUFORD
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State | GA
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Zip | 30518-5401
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Country | US
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Telephone | 770-904-9014
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Fax | 770-904-9011
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. JACK WRIGHT
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Credential |
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Telephone | 706-248-8456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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