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NPI Code Detail

MEDICARE: CAEDEL MEDICAL GROUP

MEDICARE: CAEDEL MEDICAL GROUP
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
1207R00000XInternal Medicine Physician039177GA

General Provider Information

NPI Number : 1710922075
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAEDEL MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 9
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-0009
Country : US
Telephone Number : 770-907-4949
Fax Number : 770-907-4022
Provider Business Practice Location Address
First Line : 1324 HIGHWAY 138 SW
Second Line :
City : RIVERDALE
State : GA
Zip : 30296-1404
Country : US
Telephone Number : 770-907-4949
Fax Number : 770-907-4022
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : CLAIRE K WILLIE
Credential : MD
Telephone Number : 770-907-4949
Provider Enumeration Date : 06/19/2006
Last Update Date : 08/02/2011

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Directions to “CAEDEL MEDICAL GROUP ” Practice Location

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