Organization · NPI-2
Cantrell Lake Inpatient Services LLC
Hospitalist · Bremen, GA
NPI number1497281133
StatusActive
Last updated in NPPESMar 27, 2023
Details
- NPI
- 1497281133
- Entity type
- Organization (NPI-2)
- Legal business name
- Cantrell Lake Inpatient Services LLC
- Organization subpart
- No
- Enumeration date
- May 1, 2017
- Certification date
- Mar 27, 2023
- Last updated
- Mar 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208M00000X | Hospitalist | – | – | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
200 Allen Memorial DrBremen, GA 30110-2012
Phone 973-251-1132
Mailing address
13737 Noel Rd1600
Dallas, TX 75240-1331
Phone 973-251-1132
Authorized official
Karen Vaughn
Officer
4044504684
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