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NPI Code Detail

MEDICARE: CENTRAL GEORGIA TOTAL CARE, LLC

MEDICARE: CENTRAL GEORGIA TOTAL CARE, 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
1207Q00000XFamily Medicine Physician021140GA

General Provider Information

NPI Number : 1710379649
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL GEORGIA TOTAL CARE, LLC
Provider Business Mailing Address
First Line : 644 TALLULAH TRL
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-7625
Country : US
Telephone Number : 478-333-2100
Fax Number : 478-333-5201
Provider Business Practice Location Address
First Line : 644 TALLULAH TRL
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-7625
Country : US
Telephone Number : 478-333-2100
Fax Number : 478-333-5201
Authorized Official
Title or Position : OWNER
Name : RALPH AUSTIN JR.
Credential : MD
Telephone Number : 478-747-9317
Provider Enumeration Date : 03/02/2015
Last Update Date : 03/02/2015

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Directions to “CENTRAL GEORGIA TOTAL CARE, LLC ” Practice Location

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