MEDICARE: CAREHALO ALABAMA LLC

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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1467009217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREHALO ALABAMA LLC

Provider Business Mailing Address
First Line	:	5200 DALLAS HWY STE 200-243
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6318
Country	:	US
Telephone Number	:	770-364-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 DALLAS HWY STE 200-243
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6318
Country	:	US
Telephone Number	:	770-364-2184
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TAMIKA S GOINS
Credential	:
Telephone Number	:	770-364-2184

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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Directions to “CAREHALO ALABAMA LLC ” Practice Location

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