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General NPI Number Information
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NPI Number | 1568385409
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE PATHWAY, LLC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 6470 E JOHNS XING STE 160
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1500
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Country | US
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Telephone | 770-988-4956
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Fax | 770-988-4956
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Provider Business Mailing Address
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Address Line | 990 PEACHTREE INDUSTRIAL BLVD UNIT 1207
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City | SUWANEE
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State | GA
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Zip | 30024-5209
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Country | US
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Telephone | 770-988-4956
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KOEKLAND THOMAS
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Credential |
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Telephone | 770-988-4956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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