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General NPI Number Information
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NPI Number | 1194079939
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Entity Type | Organization
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Legal Business Name | CARE PREMIER PLUS
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 4776 LAMB AVE
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City | UNION POINT
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State | GA
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Zip | 30669-1121
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Country | US
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Telephone | 706-486-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 4776 LAMB AVE
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City | UNION POINT
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State | GA
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Zip | 30669-1121
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Country | US
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Telephone | 706-486-2481
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SHELDON B EBERHART
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Credential |
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Telephone | 404-548-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | GA67890
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License Number State | GA
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