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General NPI Number Information
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NPI Number | 1174856397
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Entity Type | Organization
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Legal Business Name | CARE DYNAMIX, INC,
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 235 HEMBREE PARK DR SUITE 300
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City | ROSWELL
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State | GA
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Zip | 30076-5738
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Country | US
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Telephone | 770-512-8566
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Fax | 770-512-8558
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Provider Business Mailing Address
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Address Line | 235 HEMBREE PARK DR SUITE 300
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City | ROSWELL
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State | GA
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Zip | 30076-5738
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Country | US
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Telephone | 770-512-8566
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Fax | 770-512-8558
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Authorized Official
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Title or Position | CONTROLLER
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Name | PAM RILEY
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Credential |
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Telephone | 770-512-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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