Basic Information
| Provider Information | |||||||||
| NPI: | 1639530058 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARE1 SC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2030 POWERS FERRY RD SE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788012329 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2030 POWERS FERRY RD SE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788012329 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2016 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6788012329 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.