MEDICARE: COMPREHENSIVE CARE MEDICAL L.L.C

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	016356	GA

General Provider Information

NPI Number	:	1831313683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CARE MEDICAL L.L.C

Provider Business Mailing Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

Provider Business Practice Location Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DANA Y PAINE
Credential	:
Telephone Number	:	770-439-0198

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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