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General NPI Number Information
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NPI Number | 1063853364
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Entity Type | Organization
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Legal Business Name | CMO OF GEORGIA, LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 6728 CHESEPEAKE TRL
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City | REX
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State | GA
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Zip | 30273-2229
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Country | US
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Telephone | 404-664-6183
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 258
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City | MORROW
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State | GA
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Zip | 30260-0258
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Country | US
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Telephone | 404-664-6183
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MS. ALCENIA COLEMAN
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Credential | RN
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Telephone | 404-664-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN163373
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | RN163373
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License Number State | GA
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