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General NPI Number Information
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NPI Number | 1164729646
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Entity Type | Organization
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Legal Business Name | ANDERSON'S CCBI
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 1581 QUEEN ELIZABETH DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3660
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Country | US
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Telephone | 678-265-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 1581 QUEEN ELIZABETH DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3660
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Country | US
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Telephone | 678-265-0809
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LINDA E ANDERSON
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Credential |
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Telephone | 678-265-0809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | RBI002004
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License Number State | GA
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