MEDICARE: FLEMING MEDICAL CENTER 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
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1568705572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLEMING MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1203 CLEVELAND AVE
Second Line	:	1 A
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	678-783-7845
Fax Number	:	404-973-3256

Provider Business Practice Location Address
First Line	:	1203 CLEVELAND AVE
Second Line	:	1 A
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	678-783-7845
Fax Number	:	404-973-3256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN DIEGO ROMERO
Credential	:
Telephone Number	:	678-886-8665

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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