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General NPI Number Information
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NPI Number | 1811250244
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Entity Type | Organization
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Legal Business Name | CANDID MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 6525 PROFESSIONAL PL SUITE C
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City | RIVERDALE
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State | GA
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Zip | 30274-2519
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Country | US
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Telephone | 770-994-1250
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Fax | 770-994-1295
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Provider Business Mailing Address
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Address Line | 6525 PROFESSIONAL PL SUITE C
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City | RIVERDALE
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State | GA
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Zip | 30274-2519
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Country | US
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Telephone | 770-994-1250
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Fax | 770-994-1295
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. BRYAN PRESTON CAUDILL
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Credential |
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Telephone | 404-718-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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