MEDICARE: CARE DYNAMIX 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	261QP0904X	Federal Public Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00355634	OTHER		RAILROAD MEDICARE PROVIDE

General Provider Information

NPI Number	:	1518061233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE DYNAMIX LLC

Provider Business Mailing Address
First Line	:	235 HEMBREE PARK DR
Second Line	:	SUITE 300
City	:	ROSWELL
State	:	GA
Zip	:	30076-5700
Country	:	US
Telephone Number	:	770-512-8566
Fax Number	:	770-512-8558

Provider Business Practice Location Address
First Line	:	235 HEMBREE PARK DR
Second Line	:	SUITE 300
City	:	ROSWELL
State	:	GA
Zip	:	30076-5700
Country	:	US
Telephone Number	:	770-512-8566
Fax Number	:	770-512-8558

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. DAVID JASON GREIFF
Credential	:
Telephone Number	:	770-512-8566

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	09/05/2007

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