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General NPI Number Information
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NPI Number | 1134775208
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Entity Type | Organization
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Legal Business Name | CARL BEAN MENS HEALTH AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2140 M L KING JR DR SW 2140 M L KING JR DR SW-BLDG. B
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City | ATLANTA
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State | GA
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Zip | 30310-1134
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Country | US
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Telephone | 404-609-3197
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Fax | 404-691-8809
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Provider Business Mailing Address
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Address Line | 2140 M L KING JR DR SW BLDG. B
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City | ATLANTA
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State | GA
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Zip | 30310-1134
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Country | US
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Telephone | 404-660-0527
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Fax | 404-691-8809
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Authorized Official
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Title or Position | PRESIDENT/BOARD CHAIR
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Name | MR. RUDOLPH H CARN
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Credential |
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Telephone | 404-660-0527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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