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General NPI Number Information
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NPI Number | 1174859367
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Entity Type | Organization
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Legal Business Name | CONVENIENT CARE MD, LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 111 FIELDSTONE DR STE 114
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7108
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Country | US
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Telephone | 478-414-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 690
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City | MILLEDGEVILLE
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State | GA
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Zip | 31059-0690
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Country | US
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Telephone | 478-414-1414
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. ALAN HORTON
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Credential |
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Telephone | 478-454-3850
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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 | GA
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