My Chronic Care Management
Clinic/Center, Pain in Marietta, GA. Organization (NPI-2).
NPI number1164045548
StatusActive
Last updated in NPPESOct 20, 2020
Details
- NPI
- 1164045548
- Entity type
- Organization (NPI-2)
- Legal business name
- My Chronic Care Management
- Organization subpart
- No
- Enumeration date
- May 20, 2020
- Certification date
- Sep 30, 2020
- Last updated
- Oct 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP3300X | Clinic/Center, Pain | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Practice location
20 Whitlock Pl Sw Ste 101Marietta, GA 30064-3176
Phone 770-635-7166 · Fax 404-591-8002
Mailing address
Po Box 2198Kennesaw, GA 30156-9102
Phone 770-635-7166 · Fax 404-591-8002
Authorized official
Maurice L Woodard
President
4043095200
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