Organization Name: | C & C MEDICAL GROUP |
NPI Number: | 1871649525 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CONNIE COUCH (PRESIDENT) |
Mailing Address: | 1384 Battlefield Pkwy Fort Oglethorpe |
State: | GA US |
Postal Code: | 307424010 |
Phone Number: | 7068612700 |
Fax Number: | 7068612745 |
NPI Enumeration Date: | 01/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |