NPI 1316389901

Community Based Healthcare Services

Organisation Preferred Provider Organization Tucker, GA

Practice location

Address: 2374 Main St STE B, Tucker, GA 30084-4533
Phone: (678) 964-7107

Authorised official

Name: Derrick Boswell
Title: Director
Phone: (678) 964-7107

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

Other Preferred Provider Organization providers in Georgia →

Registry record

NPI: 1316389901
Entity type: Organization
NPI issued: 23 Jul 2013
Record last updated: 23 Jul 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.