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General NPI Number Information
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NPI Number | 1477913838
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE SOLUTIONS, INC.
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 2325 LOG CABIN DR SE STE 107
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City | VININGS
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State | GA
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Zip | 30339-6742
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Country | US
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Telephone | 770-432-1199
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Fax | 770-432-1195
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Provider Business Mailing Address
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Address Line | 2325 LOG CABIN DR SE STE 107
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City | VININGS
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State | GA
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Zip | 30339-6742
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Country | US
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Telephone | 770-432-1199
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Fax | 770-432-1195
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Authorized Official
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Title or Position | CEO
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Name | DR. KENNETH LENNELL MCRAE
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Credential | D.C.
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Telephone | 770-432-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CHIR008066
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License Number State | GA
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