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NPI Code Detail

MEDICARE: COMMUNITY ANCILLARY SERVICES, INC.

MEDICARE: COMMUNITY ANCILLARY SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care PharmacyPHRE008075GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22020178OTHERPK

General Provider Information

NPI Number : 1235121617
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY ANCILLARY SERVICES, INC.
Provider Business Mailing Address
First Line : PO BOX 1038
Second Line :
City : ACWORTH
State : GA
Zip : 30101-8938
Country : US
Telephone Number : 770-974-4277
Fax Number : 770-974-4208
Provider Business Practice Location Address
First Line : 4769 S MAIN ST
Second Line :
City : ACWORTH
State : GA
Zip : 30101-5339
Country : US
Telephone Number : 770-974-4277
Fax Number : 770-974-4208
Authorized Official
Title or Position : SENIOR VICE PRESIDENT
Name : JAMES LEE
Credential :
Telephone Number : 478-783-1515
Provider Enumeration Date : 08/22/2005
Last Update Date : 03/11/2021

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Directions to “COMMUNITY ANCILLARY SERVICES, INC. ” Practice Location

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