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General NPI Number Information
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NPI Number | 1144273608
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE CONCEPTS, INC.
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1943 SAYBROOK CT
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City | JONESBORO
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State | GA
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Zip | 30236-2681
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Country | US
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Telephone | 770-478-6091
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Fax | 770-478-6875
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Provider Business Mailing Address
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Address Line | 1943 SAYBROOK CT
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City | JONESBORO
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State | GA
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Zip | 30236-2681
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Country | US
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Telephone | 770-478-6091
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Fax | 770-478-6875
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. JUSTIN M WAITS
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Credential |
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Telephone | 770-478-6091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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