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General NPI Number Information
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NPI Number | 1225289366
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Entity Type | Organization
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Legal Business Name | CONCENTRA
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 3980 WILLOW RIDGE RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2774
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Country | US
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Telephone | 770-403-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 3980 WILLOW RIDGE RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2774
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Country | US
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Telephone | 770-403-4200
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. ROBERT H JORAN JR.
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Credential | P.A.
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Telephone | 770-403-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | 001968
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License Number State | GA
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